TY - JOUR
AU - Smith, Brian J
AB - Abstract Currently, the evidence for mobile health (mHealth) smoking cessation interventions is limited and heterogeneous, warranting the need for innovative rigorously developed solutions. The aim of this study was to describe the development of a smoking cessation smartphone application (app) developed using evidence-based principles. The app (Kick.it) was designed using the Intervention Mapping framework, incorporating an extensive literature review and qualitative study, in combination with the Behavioural Change Taxonomy v1, the Theoretical Domains Framework, and the Persuasive System Design framework. Kick.it provides quit smoking education, skills training, motivational content and self-regulation functionality for smokers, as well as their social support network. By logging cravings and cigarettes smoked, users will create their own smoking profile, which will be used to provide tailored interventions. It hosts a social network to allow 24/7 social support and provides in-app tools to help with urges to smoke. The app aims to motivate smokers to retry if they slip-up or relapse, allowing them to learn from previous smoking cessation attempts. Rather than basing the app on a singular behavioral change approach, Kick.it will use elements stemming from a variety of behavioral approaches by combining methods of multiple psychological theories. The use of best-practice intervention development frameworks in conjunction with evidence-based behavioral change techniques is expected to result in a smartphone app that has an optimal chance of helping people to quit smoking. Implications Practice: The use of a rigorous intervention development framework in conjunction with evidence-based behavioral change techniques is expected to increase the chance of success of real-world implementation of a smoking cessation smartphone app. Policy: Policy makers can use the current manuscript to find a justification for an innovative collaborative project between research and industry, as well as the specific elements included in the Kick.it app. Research: The current study provides insight in the development process of a smoking cessation smartphone app that is the result of a novel collaboration between researchers and a tech start-up. Smoking cessation advice delivered by health professionals places a large focus on the use of professional counselling and pharmacotherapy [1–5]. While these have been shown to be effective in increasing quit rates [6–9], both treatment modalities suffer from drawbacks, for example, problems in treatment compliance, and smokers’ misperceptions about safety and effectiveness [10, 11]. Innovative technological solutions such as smartphone applications (apps) and wearables (also known as mHealth solutions) may be a (cost-)effective solution to the above-mentioned issues, as has been shown in other health areas [12]. They can augment and promote pharmaceutical (e.g., by stimulating medication adherence via reminders) or face-to-face (e.g., by allowing a therapist to track the patient’s behavior) treatment, and can act as a standalone behavioral change solution. Currently, the evidence for mHealth interventions for smoking cessation is however limited, and results found by trials are heterogeneous [13–16]. The aim of this study was to describe the design and development process of a smoking cessation app called Kick.it. Intervention designers can currently use two comprehensive intervention development frameworks when designing behavioral change interventions: the Intervention Mapping (IM) approach [17, 18] and the Behavioural Change Wheel (BCW) [19]. While both frameworks share a similar approach in guiding the development of an intervention, IM differs from the BCW as the BCW uses the COM-B model while IM is multitheoretical, and IM has a stronger ecologic focus, with more emphasis on taking external environmental determinants, behaviors, and outcomes into account when addressing behavioral change. By providing more freedom in choice of theoretical constructs, and its stronger ecologic focus, IM was chosen as the framework of preference. By combining IM’s rigor with persuasive system design [20], a framework for the development of technology that aims to change attitudes and behavior, this study sets out to create a social network-based smartphone app developed to stimulate the use of and interaction with the app, also referred to as app engagement [21], and subsequently smoking cessation success. MATERIALS AND METHODS The IM approach guides intervention development in a series of six steps. Step 1: Needs assessment of health behavior IM starts with an extensive analysis of the problem at hand, a needs assessment, using the PRECEDE/PROCEED model [22], which allows identification of the main problem behaviors that need to be changed, as well as the determinants that cause that the problem behavior. For instance, smokers may not want to use pharmacotherapy in their quit attempt (the problem behavior) because their knowledge (the determinant) about the effectiveness of the medication is incorrect. The needs assessment was conducted via a literature review and stakeholder input via semi-structured interviews and focus groups with smokers and health professionals, specifically hospital employees, a GP and smoking cessation counsellors (local ethics approval code HREC/15/TQEH/187). The qualitative interviews (n = 16) and focus group (n = 1, 5 members) were analyzed via deductive thematic analysis [23] using constructs from the Theoretical Domains framework (TDF) [24, 25]; a validated integrative theoretical framework consisting of 14 domains derived from synthesizing 33 behavior change theories. The needs assessment resulted in a logic model that constituted the main problems’ behaviors and determinants (stemming from the TDF) of interest. Step 2: Definition of program objectives The resulting problem behaviors (e.g., not using pharmacotherapy) and determinants (e.g., lack of knowledge on effectiveness) were transformed into behavioral and environmental outcomes (e.g., smoker uses pharmacotherapy in next quit attempt) and performance objectives (e.g., smoker demonstrates knowledge on how pharmacotherapy works). Change objectives, specific objectives that need to be achieved in order for the performance objective to be realized (e.g., smoker increases understanding of side-effects of pharmacotherapy), were constructed for each performance objective and linked to the selected determinant of interest, resulting in matrices of change; matrices depicting each change objective per performance objective (placed in the rows) and determinant (placed in the columns). Step 3: Selecting evidence-based methods and practical applications Each change objective was matched with evidence-based behavioral change techniques (BCTs) for smoking cessation and general health behavior, stemming from the behavioural change taxonomy v1 [26, 27]. The combination of change objectives and evidence-based BCTs were subsequently translated into practical applications that would be used in the intervention, practical applications being the vehicles used to operationalize each change objective (e.g., a video demonstrating what withdrawal effects a smoker can expect). Step 4: Development of Kick.it While Steps 1–3 result in the selection of evidence-based BCTs and practical applications to accomplish behavioral change, they do not provide sufficient guidance on the design of mHealth interventions. Crutzen [28] proposed to combine IM with a technology development framework when designing e- and mHealth solutions. We used the Persuasive System Design (PSD) framework [20] to guide the overall functional development of Kick.it for its comprehensiveness and ease of use. The PSD framework provides intervention designers with 28 design principles falling into four categories that aim to ensure that a system is capable of supporting sustainable health behavior change. Firstly, the category of Primary Task Support focuses on ensuring that the system provides support that helps users carry out the primary task that needs to be completed. Secondly, Dialogue Support focuses on ensuring that the system provides feedback and support to promote goal attainment. Thirdly, the system needs to have System Credibility, which ensures that the system is a credible tool to achieve the health behavior. Finally, the system should provide functionality to facilitate Social Support. Steps 5 and 6: Adoption, implementation, and evaluation plans After finishing the design of the intervention, IM concludes with two additional steps, being the development of an adoption and implementation plan (Step 5) and an evaluation plan (Step 6). These two steps are outside the scope of this article. RESULTS Step 1: Needs assessment The literature study, the interviews and focus groups, and the consultations with stakeholders highlighted a number of key areas of interest that would form the foundation for Kick.it. A narrative summary of the combined findings of the literature review and the interviews and focus groups is presented below, while more detailed information can be found in the Supplementary Appendix, Tables S1 and S4. Quit attempts are often unplanned and unassisted While there are a number of evidence-based methods to boost success rates of quit attempts, including nicotine replacement therapy (NRT; single and combination), varenicline and bupropion [7, 29], professional counselling [6, 8], or a combination of both [9, 30], a significant proportion of quit attempts is unassisted [31–33]. The specific reasons for this vary. Smokers consider quitting to be their own responsibility and do not readily accept professional behavioral support in their quit attempt [11]. As one of the smokers in the focus group indicated: Coming back to the counselling thing, I never tried those things because I believe in myself…If I quit, I quit by myself. I am picturing going [to] counselling, talking to someone just for quitting cigarettes. It is kind of like an overkill, something like that. It is crazy; like calling Quitline? I believe in myself. If I want to quit I can quit (Smoker 5) Smokers often do not discuss their intention to quit with their health professional and often quit without appropriate planning [34], despite having had the desire to quit for a long period of time. Smokers often base their knowledge of effective ways to quit on lay experiences [11] or nonscientific sources (e.g., Internet). There are a number of variables that may influence the unwillingness to use pharmacotherapy; for instance, their perceptions of its safety and effectiveness and perceived cost [35, 36]. The underuse of evidence-based support methods is particularly a problem in minority populations [37, 38]. The lack of planning and assistance can limit the ability to exert appropriate self-control in difficult situations and can limit the ability to quit successfully and stay quit [39]. Smokers who use pharmacotherapy may lack the willingness and ability to properly adhere to the treatment protocol While smokers often have used pharmacotherapy to some degree in the past, their knowledge of, and attitudes and perceptions toward pharmacotherapy are often negative and low, with smokers often thinking that pharmacotherapy does not work [35, 40–43]. As one smoker (Smoker 6) noted: “[Pharmacotherapy is] a waste of time. I have never touched them, but I know people that did and they did not succeed. I do not believe there is any medical intervention that can let you overcome an addiction”. This view is supported by views from the health professionals we interviewed who indicated that their clients often do not like pharmacotherapy. Smokers and health professionals indicate that patients often do not properly complete the treatment protocol when dealing with pharmacotherapy, which limits the effectiveness and subsequently may affect the quit rates [44, 45]. Furthermore, it is reported that smokers may be using NRT incorrectly or use it suboptimally [46]. When asking a smoking cessation counsellor (health professional 9) for her views on the effectiveness of pharmacotherapy she responded “With pharmacotherapy, yes, if they are taught the right way, and if they are provided with their support. But if you just give somebody something, they are not likely to uh succeed, so the support is really important”. While these issues are widely reported, smokers do not get taught routinely how to use their products properly or advised about what to expect when they start using the products. This is surprising as health professionals in general seem to recommend pharmacotherapy a lot in their practice, as guided by guidelines on smoking cessation [2–5]. Social support has a positive effect on cessation attempt Smoking, similar to other addictions (and in general health behaviors [47, 48]), can be influenced positively and negatively by the person’s social surroundings. Smoking is a social addiction; smokers often get into the habit of smoking in a social setting, and social settings (personal and professional) can help maintain the smoking behavior, for instance as is the case for the role of tobacco in mental health systems [49] or its association with certain professions as was mentioned by one of the smokers we interviewed: I know that my friend, being a chef in the chef culture, they go out for a cigarette for a legitimate reason to get out of the kitchen. They can finally take a break to go outside. Otherwise they actually said they wouldn't be a smoker. (Smoker 4) The social environment can subsequently also be used to help smokers quit or reduce their chance of relapse [50, 51]. It can potentially augment the effectiveness of other treatments [52] and seems particularly important for short-term cessation [53]. While the precise methods through which social support contributes are not known, and results by studies suggest different accounts, its positive influence cannot be denied [54]. The perceived benefits of social support were acknowledged by our focus group and interview participants when they were asked what features they would like to see in the app, as voiced by smoker 3: “For me it is the human community… if you are going to succumb to a ciggie, you can find a buddy” and health professional 6: “It is definitely the social support [that is important for smoking cessation], I guess it is peer support, peer pressures and also social support from the families as well to remain abstinent". Having loved ones, specifically partners, but also siblings and friends quit smoking while the smoker also attempts to quit increases the person’s ability to successfully remain abstinent [55]. Social support seems to be especially important in smokers with a low SES or smokers from ethnic minorities [56]. Relapse is common and most smokers make multiple quit attempts Smokers face a high relapse rate and often need multiple attempts to stay smoke free for a period of time [57]. Furthermore, they often show intentions to quit on multiple occasions in a month, quickly succeeding one another [58]. Smokers indicated that they would feel like a failure after a slip-up and would more often than not contemplate recommence smoking (i.e., relapse). This is supported by literature suggesting that slip-ups more often lead to relapse [59], rather than to dismissing the cigarette as a slip-up and to continue the cessation attempt, which is also known as the abstinence violation effect [60]. As health professional 8 noted “It is pretty important to get across [to the smoker] that just because you slipped once that does not mean that you are back to being a smoker. You can still get rid of it”. Motivation to quit can predict future quit attempts but does not predict future relapse [61]. Relapse rates are highest in the early stages of the smoking cessation attempt [62], but a fairly high proportion of smokers still relapse within 10 years, although the risk of relapse decreases over time [63]. Estimates of long-term relapse vary between studies depending on methodology, but one meta-analysis has indicated that about 10% (95% CI of 5%–17%), relapse after 1 year [64]. Belonging to an ethnic minority and lower social class increases relapse rates [38, 65]. Individual characteristics predict (quit) smoking behavior One of the main predictors of success rate (and thus a predictor of relapse) is nicotine dependence [66]. Furthermore, marital status and living with a partner who does not smoke influences cessation rates. Other variables of specific interest are the influence of gender, age, socioeconomic status (SES), educational level, ethnicity, stress level and influence of psychological well-being or mental illness, and other substance abuse [66–72]. Furthermore, our interviews with smokers indicated a wide variety of motivations that would drive the smokers to want to quit, implying the need for individualized treatment solutions. This was repeated by almost all of the interviewed health professionals, for instance: I don’t think there is any one tried and truth method. It’s what works for the individual and I think it has to be individualized to what the patient…will accept, what their beliefs are of the different treatments, because they will already have some pre-conceived ideas, whether or not they are willing to accept that additional support, which is so valuable, and how they will have that support. (Health professional 5) Health professionals are often not formally educated on or appropriately resourced for smoking cessation support Health professionals are often not educated appropriately on smoking cessation, or at least perceive that they are not [73, 74]. This is supported by our interviews with health professionals: I might have been to a lecture… as a junior trainee. As a senior trainee there wasn’t a lot of structured teaching. I have learnt most from what [my colleague] has taught to GPs or ad hoc as a registrar learning from my seniors… There was hardly any [smoking cessation education] at all. (Health professional 1) Smoking cessation education status often depends on the individual motivation of the health professional and their specific roles. As one nurse (health professional 5) noted “I saw [smoking cessation training] as something that would add to my role as I do deal with people who relapse with smoking… I did choose to do those courses [on my own accord]”. Other major problems are the lack of resources (including access to smoking cessation counsellors) and time to provide counselling [75–77] as well as the perceived motivation and the pessimistic views of some health professionals on the ability of smokers to quit successfully [78, 79]. With the exception of one smoking cessation expert, none of the health professionals interviewed had ever used or recommended the use of technological solutions for smoking cessation. Step 2: Formulation of program objectives The first four topics of the needs assessment would become the principle focus of the intervention. The first of the two other topics, being “individual characteristics predict success rate” will be addressed in Step 4 (design of Kick.it). The second of the topics, being “health professionals lack training and resources to provide smoking cessation advice”, was deemed to be outside the scope of the current manuscript and would not be the focus of the first versions of Kick.it. The four selected problem areas were transformed into four behavioral outcomes and one environmental outcome, and matched with the main determinants of influence (derived from the TDF [24] domains) that were identified in the needs assessment, leading to the creation of the logic model of the intervention, see Fig. 1. The determinants specifically were Fig 1 View largeDownload slide Logic model of the intervention as determined by the needs assessment of Sep 1. The five selected TDF [24] determinants in the left box are the focus of the intervention and influence the ability to achieve the five problem behaviors depicted in the two middle boxes. The four behaviors of the smoker (upper middle box) are influenced by individual characteristics, shown in the upper right box. If Kick.it is successful, it leads to the result displayed in the lower right box; an increase in the ability to successfully quit smoking. Fig 1 View largeDownload slide Logic model of the intervention as determined by the needs assessment of Sep 1. The five selected TDF [24] determinants in the left box are the focus of the intervention and influence the ability to achieve the five problem behaviors depicted in the two middle boxes. The four behaviors of the smoker (upper middle box) are influenced by individual characteristics, shown in the upper right box. If Kick.it is successful, it leads to the result displayed in the lower right box; an increase in the ability to successfully quit smoking. • Smokers need to have objective knowledge about smoking and successful smoking cessation. • Smokers need to demonstrate skills in medication use, formulating a smoking cessation strategy and utilizing their social support network. • Smokers need to maintain their beliefs in the capability to successfully quit the habits and develop positive beliefs in the consequences of using evidence-based smoking cessation methods to aid them in their attempt. • Smokers need to be able to demonstrate behavioral regulation, specifically they need to demonstrate optimal self-control and engage in self-monitoring to allow for adjustment of their quit behavior. The behavioral outcomes were further specified into performance objectives, see Table 1, with change objectives subsequently being formulated per TDF determinant that was considered to be relevant to the specific performance objective. The matrices of change, detailing each change objective and their relationship to the performance objectives and TDF determinants, can be found in Supplementary Appendix, Tables S5–S9. Table 1 Behavioral and environmental outcomes, and performance objectives (PO) for Kick.it Behavioral outcome 1: Smoker develops a quit strategy  PO 1.1  Demonstrates understanding of effects of smoking cessation on physical and psychological well-being  PO 1.2  Demonstrates understanding of effective support methods to quit smoking  PO 1.3  Shows knowledge on effective ways to increase self-control  PO 1.4  Develops personal quit strategy  PO 1.5  Executes personal quit strategy  PO 1.6  Evaluates current quit smoking strategy  PO 1.6.1  Judges whether quit smoking strategy is effective  PO 1.6.2  Re-evaluates quit smoking strategy if not effective  Behavioral outcome 2: Smoker adheres to pharmacotherapy treatment plan  PO 2.1  Recognizes the need to use pharmacotherapy (if appropriate)  PO 2.2  Selects appropriate pharmacotherapy option to aid in cessation effort  PO 2.3  Acquires pharmacotherapy  PO 2.4  Generates understanding of how to effectively use pharmacotherapy  PO 2.5  Adheres to pharmacotherapy treatment protocol as prescribed  PO 2.6  Appraises effectiveness of pharmacotherapy  PO 2.6.1  Judges whether pharmacotherapy is effective  PO 2.6.2  Changes pharmacotherapy if necessary  Behavioral outcome 3: Smoker utilizes social support network  PO 3.1  Recognizes need to get social support in quit attempt  PO 3.2  Determines situations in which social support is necessary  PO 3.3  Sets up rules with social environment to provide support  PO 3.4  Use selected social support if needed  PO 3.5  Evaluate effectiveness of support  PO 3.5.1  Judge whether support contact is providing appropriate support  PO 3.5.2  Re-evaluate/improve existing support network if current network is not supportive  Behavioral outcome 4: Smoker resumes quit attempt as soon as possible after slip-up or relapse  PO 4.1  Determines cause and reason for slip-up and relapse  PO 4.2  Understands difference between slip-up and relapse  PO 4.3  Appraises slip-up and relapse correctly  PO 4.4  Realizes need to retry smoking cessation as soon as possible  PO 4.5  Evaluates current quit smoking strategy  PO 4.5.1  Judges whether quit smoking strategy is effective  PO 4.5.2  Re-evaluates quit smoking strategy if not effective  Environmental outcome 1: Social environment provides support during the smokers’ cessation attempt  PO 5.1  Social actor recognizes need to provide support in smokers cessation attempt  PO 5.2  Social actor develops understanding on effective ways to quit smoking  PO 5.3  Social actor develops understanding on how to provide support  PO 5.4  Social actor sets up support agreement  PO 5.5  Social actor provides support during quit attempt  PO 5.5.1  Social actor ensures that smoker enables quit strategy  PO 5.5.2  Social actor appraises potential issues in smoking cessation effort  PO 5.5  Social actor evaluates own social support  PO 5.6.1  Social actor judges whether support is adequate  PO 5.6.2  Re-evaluates quit smoking support if not effective  Behavioral outcome 1: Smoker develops a quit strategy  PO 1.1  Demonstrates understanding of effects of smoking cessation on physical and psychological well-being  PO 1.2  Demonstrates understanding of effective support methods to quit smoking  PO 1.3  Shows knowledge on effective ways to increase self-control  PO 1.4  Develops personal quit strategy  PO 1.5  Executes personal quit strategy  PO 1.6  Evaluates current quit smoking strategy  PO 1.6.1  Judges whether quit smoking strategy is effective  PO 1.6.2  Re-evaluates quit smoking strategy if not effective  Behavioral outcome 2: Smoker adheres to pharmacotherapy treatment plan  PO 2.1  Recognizes the need to use pharmacotherapy (if appropriate)  PO 2.2  Selects appropriate pharmacotherapy option to aid in cessation effort  PO 2.3  Acquires pharmacotherapy  PO 2.4  Generates understanding of how to effectively use pharmacotherapy  PO 2.5  Adheres to pharmacotherapy treatment protocol as prescribed  PO 2.6  Appraises effectiveness of pharmacotherapy  PO 2.6.1  Judges whether pharmacotherapy is effective  PO 2.6.2  Changes pharmacotherapy if necessary  Behavioral outcome 3: Smoker utilizes social support network  PO 3.1  Recognizes need to get social support in quit attempt  PO 3.2  Determines situations in which social support is necessary  PO 3.3  Sets up rules with social environment to provide support  PO 3.4  Use selected social support if needed  PO 3.5  Evaluate effectiveness of support  PO 3.5.1  Judge whether support contact is providing appropriate support  PO 3.5.2  Re-evaluate/improve existing support network if current network is not supportive  Behavioral outcome 4: Smoker resumes quit attempt as soon as possible after slip-up or relapse  PO 4.1  Determines cause and reason for slip-up and relapse  PO 4.2  Understands difference between slip-up and relapse  PO 4.3  Appraises slip-up and relapse correctly  PO 4.4  Realizes need to retry smoking cessation as soon as possible  PO 4.5  Evaluates current quit smoking strategy  PO 4.5.1  Judges whether quit smoking strategy is effective  PO 4.5.2  Re-evaluates quit smoking strategy if not effective  Environmental outcome 1: Social environment provides support during the smokers’ cessation attempt  PO 5.1  Social actor recognizes need to provide support in smokers cessation attempt  PO 5.2  Social actor develops understanding on effective ways to quit smoking  PO 5.3  Social actor develops understanding on how to provide support  PO 5.4  Social actor sets up support agreement  PO 5.5  Social actor provides support during quit attempt  PO 5.5.1  Social actor ensures that smoker enables quit strategy  PO 5.5.2  Social actor appraises potential issues in smoking cessation effort  PO 5.5  Social actor evaluates own social support  PO 5.6.1  Social actor judges whether support is adequate  PO 5.6.2  Re-evaluates quit smoking support if not effective  View Large Table 1 Behavioral and environmental outcomes, and performance objectives (PO) for Kick.it Behavioral outcome 1: Smoker develops a quit strategy  PO 1.1  Demonstrates understanding of effects of smoking cessation on physical and psychological well-being  PO 1.2  Demonstrates understanding of effective support methods to quit smoking  PO 1.3  Shows knowledge on effective ways to increase self-control  PO 1.4  Develops personal quit strategy  PO 1.5  Executes personal quit strategy  PO 1.6  Evaluates current quit smoking strategy  PO 1.6.1  Judges whether quit smoking strategy is effective  PO 1.6.2  Re-evaluates quit smoking strategy if not effective  Behavioral outcome 2: Smoker adheres to pharmacotherapy treatment plan  PO 2.1  Recognizes the need to use pharmacotherapy (if appropriate)  PO 2.2  Selects appropriate pharmacotherapy option to aid in cessation effort  PO 2.3  Acquires pharmacotherapy  PO 2.4  Generates understanding of how to effectively use pharmacotherapy  PO 2.5  Adheres to pharmacotherapy treatment protocol as prescribed  PO 2.6  Appraises effectiveness of pharmacotherapy  PO 2.6.1  Judges whether pharmacotherapy is effective  PO 2.6.2  Changes pharmacotherapy if necessary  Behavioral outcome 3: Smoker utilizes social support network  PO 3.1  Recognizes need to get social support in quit attempt  PO 3.2  Determines situations in which social support is necessary  PO 3.3  Sets up rules with social environment to provide support  PO 3.4  Use selected social support if needed  PO 3.5  Evaluate effectiveness of support  PO 3.5.1  Judge whether support contact is providing appropriate support  PO 3.5.2  Re-evaluate/improve existing support network if current network is not supportive  Behavioral outcome 4: Smoker resumes quit attempt as soon as possible after slip-up or relapse  PO 4.1  Determines cause and reason for slip-up and relapse  PO 4.2  Understands difference between slip-up and relapse  PO 4.3  Appraises slip-up and relapse correctly  PO 4.4  Realizes need to retry smoking cessation as soon as possible  PO 4.5  Evaluates current quit smoking strategy  PO 4.5.1  Judges whether quit smoking strategy is effective  PO 4.5.2  Re-evaluates quit smoking strategy if not effective  Environmental outcome 1: Social environment provides support during the smokers’ cessation attempt  PO 5.1  Social actor recognizes need to provide support in smokers cessation attempt  PO 5.2  Social actor develops understanding on effective ways to quit smoking  PO 5.3  Social actor develops understanding on how to provide support  PO 5.4  Social actor sets up support agreement  PO 5.5  Social actor provides support during quit attempt  PO 5.5.1  Social actor ensures that smoker enables quit strategy  PO 5.5.2  Social actor appraises potential issues in smoking cessation effort  PO 5.5  Social actor evaluates own social support  PO 5.6.1  Social actor judges whether support is adequate  PO 5.6.2  Re-evaluates quit smoking support if not effective  Behavioral outcome 1: Smoker develops a quit strategy  PO 1.1  Demonstrates understanding of effects of smoking cessation on physical and psychological well-being  PO 1.2  Demonstrates understanding of effective support methods to quit smoking  PO 1.3  Shows knowledge on effective ways to increase self-control  PO 1.4  Develops personal quit strategy  PO 1.5  Executes personal quit strategy  PO 1.6  Evaluates current quit smoking strategy  PO 1.6.1  Judges whether quit smoking strategy is effective  PO 1.6.2  Re-evaluates quit smoking strategy if not effective  Behavioral outcome 2: Smoker adheres to pharmacotherapy treatment plan  PO 2.1  Recognizes the need to use pharmacotherapy (if appropriate)  PO 2.2  Selects appropriate pharmacotherapy option to aid in cessation effort  PO 2.3  Acquires pharmacotherapy  PO 2.4  Generates understanding of how to effectively use pharmacotherapy  PO 2.5  Adheres to pharmacotherapy treatment protocol as prescribed  PO 2.6  Appraises effectiveness of pharmacotherapy  PO 2.6.1  Judges whether pharmacotherapy is effective  PO 2.6.2  Changes pharmacotherapy if necessary  Behavioral outcome 3: Smoker utilizes social support network  PO 3.1  Recognizes need to get social support in quit attempt  PO 3.2  Determines situations in which social support is necessary  PO 3.3  Sets up rules with social environment to provide support  PO 3.4  Use selected social support if needed  PO 3.5  Evaluate effectiveness of support  PO 3.5.1  Judge whether support contact is providing appropriate support  PO 3.5.2  Re-evaluate/improve existing support network if current network is not supportive  Behavioral outcome 4: Smoker resumes quit attempt as soon as possible after slip-up or relapse  PO 4.1  Determines cause and reason for slip-up and relapse  PO 4.2  Understands difference between slip-up and relapse  PO 4.3  Appraises slip-up and relapse correctly  PO 4.4  Realizes need to retry smoking cessation as soon as possible  PO 4.5  Evaluates current quit smoking strategy  PO 4.5.1  Judges whether quit smoking strategy is effective  PO 4.5.2  Re-evaluates quit smoking strategy if not effective  Environmental outcome 1: Social environment provides support during the smokers’ cessation attempt  PO 5.1  Social actor recognizes need to provide support in smokers cessation attempt  PO 5.2  Social actor develops understanding on effective ways to quit smoking  PO 5.3  Social actor develops understanding on how to provide support  PO 5.4  Social actor sets up support agreement  PO 5.5  Social actor provides support during quit attempt  PO 5.5.1  Social actor ensures that smoker enables quit strategy  PO 5.5.2  Social actor appraises potential issues in smoking cessation effort  PO 5.5  Social actor evaluates own social support  PO 5.6.1  Social actor judges whether support is adequate  PO 5.6.2  Re-evaluates quit smoking support if not effective  View Large Step 3: Selecting evidence-based methods and practical applications The change objectives formulated in Step 2 were matched to evidence-based BCTs in Step 3. They were matched with BCTs specifically used in smoking cessation research [26], and to BCTs used in general behavioral change [27] as combining them would give us more practical methods to achieve the change we wanted to reach. The BCTs were translated into practical apps that would be utilized in the app. Table 2 provides all an overview of all change objectives matched with BCTs, practical applications within kick.it, and a description of the content of the practical applications. Specific technical functionality of the app will be further described in Step 4. Table 2 Change objectives of Kick.it matched with evidence-based behavioral change techniques (BCTs) and practical applications in the app Behavioral outcome 1: Smoker develops a personal quit strategy after downloading Kick.it  TDF  PO  Change objectives  Smoking BCT  BCT  Practical applications  Content of practical application  Knowledge    Demonstrates understanding of    1.1  - withdrawal effects associated with smoking cessation  BM1, BM5, RC6  4.2, 5.1  Educational videos and text, discussion in social network  The user will be presented with information on withdrawal effects, what they are, what to expect, and how long they last. Other users share their own experiences on the social platform.  1.1  - the role of cravings in smoking (cessation)  BM1, BM5  4.2, 5.1  Educational videos and text, discussion in social network  The user will learn what cravings are, what to expect in the short and the long term, and how long they last. Other users share their own experiences on the social platform.  1.1  - the role of the social environment in smoking (cessation)  A2, BS11, BM5  3.1, 4.2, 5.3  Educational videos and text, discussion in social network  The user will learn about the positive effects of social support and the potential negative consequences of peer pressure, as well as how it helped other users.  1.1  - physical and psychological consequences of smoking cessation  BM1, BM5  5.1, 9.2  Educational videos and text, discussion in social network  The user will receive information on physical and mental consequences of smoking cessation, if and when they occur and what to do when they happen. They will be asked to determine pros and cons of smoking cessation. Other users share their own experiences on the social platform.  1.2  - evidence-based smoking cessation support methods  A1, A5, BM5  4.1, 5.1, 6.1, 11.1  Educational videos and text, discussion in social network  The user will receive information on all different kinds of pharmaceutical and behavioural methods and will learn about positive effects as well as potential side-effects to monitor and what to do when they happen. Other users share their own experiences on the social platform.  1.3  - effective self-control strategies to aid in smoking cessation  BM5,BS1, BS2, BS7, BS8, BS10, BS11  4.2, 11.2, 11.3, 12.1–12.6  Educational videos and text, discussion in social network  The user will learn about effective strategies to increase self-control and what to do to increase the chances of success (e.g., limit ego depletion, change routine, limit cue exposure, self-affirmation). Other users share their own experiences on the social platform.  1.3  - the role of 5D’s in quit attempt  A1, A2, BM1, BS2  3.1, 4.2, 6.1, 11.1, 12.4  Educational videos and text, discussion in social network  The user will get education on 5D’s (Drink water, Deep breathe, Do something Else, Delay, and Discuss with social support) and why they can help deal with cravings. Other users share their own experiences on the social platform.    Distinguish between    1.1  - facts on smoking (cessation) from lay (mis) perceptions  BM1, RC8, R13  4.2, 5.1  Educational videos and text  The user will get information on common myths and is asked to compare their own experiences with facts (e.g., cigarettes and stress).  1.2  - lay (mis)perceptions about evidence-based support methods from facts  A1, BM1, RC8, R13  4.1, 5.1, 11.1  Educational videos and text  The user is asked to view a video or read a text about various factors associated with smoking cessation (e.g., pharmacotherapy use) and is then asked to compare their own experience with the information provided in the video/text.      Demonstrates ability to    Skills  1.5  - use pharmacotherapy according to prescription (if selected)  A1, BS2, BS3  1.4, 4.1, 6.1, 7.1, 8.3, 11.1  Educational video and text, reminders, logging of medication use, reminders  The smoker will view information that explains how to properly use pharmacotherapy. They can log their medication intake and craving pattern, and prompts and cues will be given to remind them to use the medication consistently.  1.5  - use of the 5D’s when craving  BS2, BS3  1.4, 4.1, 6.1, 7.1, 8.2, 8.3  Kick Stack, Educational video and text, reminders  After logging each smoke and crave, the smoker will be presented with random suggestions of 5D’s. Social support is facilitated via the social network.  1.5  - contact social actors according to social support rules  A2, BS2, BS3  1.4, 3.1, 7.1  Social network, reminders, Educational video and text  The user has access to social support network on the app. They furthermore receive reminders and prompts to utilize social network when needed (e.g., when cravings or withdrawal symptoms are strong). Videos and text are given that provide examples on how to broach the topic with social actors.  1.5  - implement self-control strategies before and during quit attempt  A5, BS2, BS3, BS7–BS11  1.2, 1.4, 3.1, 6.1, 7.1, 11.2, 11.3, 12.1–12.6  Educational videos and text, reminders, missions  The user can complete daily missions that aim to ensure they stick to the self-control strategy. Reminders are given repeatedly.  Beliefs about capabilities    Demonstrates confidence    1.1  - toward successfully quitting smoking  BM2, BM3, BM8, RC10, RI2  2.2, 13.4, 13.5, 15.1–15.4  Missions, feed posts, health and money feedback, social support, normative feedback  The user is reminded of ex-smoking identity, is motivated throughout and reminded of personal strength (e.g., via self-affirmation). Normative information on other smokers is provided as reference point. Health feedback and feedback of supporters are used to boost motivation further.  1.4  - that chosen smoking cessation strategy will be optimal solution for quit attempt  BM2, RD2, RI2  2.2, 15.1–15.4  Missions, feed posts, social network  The user is asked to actively think about the chosen quit strategy before the quit attempt to ensure it is the most optimal solution at the time. Choice is emphasized. The social network is prompted to provide supportive messages.  1.5  - in successfully executing chosen quit smoking strategy  BM2, RD2, RI2  2.2, 13.5, 15.1–15.4  Missions, feed posts, social network  The user is asked to commit to a quit strategy and to visualize the strategy working in the quit attempt. The social network is prompted to provide supportive messages.    Expresses positive attitudes    1.2  - toward using evidence-based support methods  BM2, BM5, RD2  6.3, 15.1–15.4  Prompts, feed posts, health and money feedback, social support, normative feedback, feed posts  The user is reminded of success rate of evidence-based support and coping models are used to bolster efficacy. Information on side-effects is provided. Normative information on other smokers is provided as reference point. Smoker is asked to visualize performing the behavior.  1.6.2  - toward changing quit smoking strategy if strategy is not working according to expectations  BM2, RD2  15.1–15.4  Missions, feed posts  The user will be prompted to (imagine) changing their quit smoking strategy if it is not appropriate or leads to undesirable results.  Behavioral regulation  1.4  Identifies effective strategies from past quit attempts  RI1, RI3  15.3  Missions, feed posts  The user is asked to evaluate previous quit attempts to see what worked and what did not.  1.4  Summarizes selected quit strategy  BS3, BS4, RC9  1.1, 1.3, 1.9  Missions, feed posts  The user is asked to repeat the quit strategy and its components (e.g., implementation intentions for dealing with high-risk situations) and determine the eventual treatment goals.  1.4  Commits to executing quit strategy  BM6  1.8, 1.9  Missions, feed posts, export to social media  The user is prompted to share the quit date and its components on Kick.it and social media.  1.5  Monitors withdrawal symptoms after quitting cigarettes  A4, BS6, RI4  2.4  Missions, feed posts  The user is reminded to monitor withdrawal symptoms and to contact a health professional if the symptoms get too much  1.5  Monitors craving pattern to understand quit smoking attempt  BS6  2.1, 2.4  Craving feedback, feed posts  The user can monitor the craving pattern via the app, based on the logged data, and is asked to actively monitor for potential trigger to avoid.  1.5  Affirms nonsmoking identity  BM8  13.5  Missions, feed posts, social network  The user is asked to construct a nonsmoking identity at multiple occasions (e.g., on social network and via missions)  1.6  Recalls chosen quit strategy  BS1  1.5  Missions, feed posts  The user is prompted to recall the quit strategy via the missions to identify what works and what does not.  1.6.1  Reviews quit strategy at regular intervals  BS1, BS5, BS6, RC8  1.2, 1.5, 1.7, 2.3, 2.4  Missions, feed posts  The user is prompted to actively review elements of the quit attempt to see what works and what does not.  1.6.1  Recognizes ineffective elements  BS1, BS5, RC8  1.2, 1.5, 1.6, 1.7  Missions, feed posts  The user is prompted to actively review elements of the quit attempt.  1.6.2  Modifies quit strategy if strategy does not work according to expectations  BS1–BS4  1.2, 1.5, 1.7  Missions, feed posts  The user is prompted to change ineffective elements of the quit strategy if necessary.  Outcome 2: Smoker adheres to pharmacotherapy treatment plan  TDF  PO  Change objectives  Smoking BCT  BCT  Practical applications  Content of practical application  Knowledge    Increases understanding of      2.1  - side-effects of smoking cessation pharmacotherapy  BM5, A1, A4  5.1, 6.2, 11.1  Educational videos and text, feed posts, social network  The user is presented with information explaining potential side-effects and what to look for. Their personal experiences are explored and the social network is engaged.    2.1  - beneficial effects of smoking cessation pharmacotherapy  BM5, A1, A4  5.1, 6.2, 11.1  Educational videos and text, feed posts, social network  The user is presented with information explaining beneficial effects of pharmacotherapy. Their personal experiences are explored and the social network is engaged.    2.2  - potential pharmacotherapy options  BM5, A1, A4  6.2, 11.1  Educational videos and text, medication list  The user is presented with educational content on pharmacotherapy. The social network is prompted to share experiences.    2.4  - exact treatment protocol of pharmacotherapy  A1  4.1, 11.1  Educational videos and text  The user will be able to read education information or watch videos explaining how to use each individual product and why they have to stick to the treatment regimen.  Skills  2.3  Acquires pharmacotherapy  A1, A3  4.1, 6.1, 11.1  Instructional videos and text, potential order button/link- out via Kick.it  The user receives information on where to get pharmacotherapy and what the potential costs are.  2.5  Demonstrates ability to use pharmacotherapy at correct dose and at correct interval  A1  4.1, 6.1, 7.1 , 11.1  Instructional videos and text, reminders, Kick Stack, CareCard, feed posts  The user will be able to read education information or watch videos explaining how to use each individual product. Furthermore, the app will give reminders to education on use of product and prompt review of its effects.  Beliefs about capabilities  2.1  Alters lay perceptions on pharmacotherapy if needed  A1, RC8, RI3  11.1, 15.3  Motivational text and video, feed, social network  The user is asked to compare factual information with lay experiences or information received from other lay sources, myths are debunked.    Demonstrates confidence    2.5  - in using pharmaceutical support according to treatment protocol  A1, BM2  11.1, 15.1–15.4  Motivational text and video, feed, social network, reminders  The user is presented with motivational text and videos. The social network is utilized to further bolster support. Reminders help them stay on track.  2.6.1  - to approach health professional in case of problems with pharmacotherapy solution  A1, BM2  11.1, 15.1–15.4  Motivational text and video, feed posts  The user is provided motivational content that aims to bolster confidence to broach medication with their health professional. Health professionals will feature in videos.  2.6.1  - to approach health professional in case of problems with pharmacotherapy solution  A1, BM2  11.1, 15.1–15.4  Motivational text and video, feed posts  The user is provided motivational content that aims to bolster confidence to broach medication with their health professional. Health professionals will feature in videos.    Expresses positive attitudes    2.1  - toward using pharmaceutical support  A1, BM2  11.1, 15.1–15.4  Motivational text and video, feed, social network  The user is provided motivational facts and videos on how pharmacotherapy will help them and has helped millions of other smokers. Other smokers are asked to share their positive experiences.  2.6.2  - toward changing pharmacotherapy if desired effect is not reached  A1, BM2  11.1, 15.1–15.4  Motivational text and video, feed, social network  The user can view information that informs changing treatment regimens is necessary for optimal results.  Behavioral regulation  2.4  Ensures to have sufficient quantity of pharmacotherapy at start of quit attempt  A1, BS3  1.4, 11.1  Missions, reminders, feed posts, social network  The user is on multiple occasions reminder to ensure to have enough product in possession. Social network is asked to verify.    2.5  Recognizes mental/ physical symptoms that trigger need for pharmacotherapy  A1, BS1  1.2, 11.1  Missions, reminders, feed posts, log a crave  The user is reminded to monitor physical and emotional symptoms that may trigger need for use of pharmacotherapy. Suggestions will be made based on cravings logged.    2.6  Recalls treatment protocol of pharmacotherapy of choice  A1, BS1  1.5, 2.3, 11.1  Missions, reminders, feed posts, CareCard  The user is prompted to review the use of pharmacotherapy in missions and in regular feed posts. CareCard may prompt treatment as well.    2.6.1  Compare expected effect of pharmacotherapy with own experience  A1, A4, BS1, BS5, BS6, RC8  1.6, 1.7, 2.4, 11.1  Missions, reminders, feed posts, CareCard  The user is reminder of information about the positive and negative effects of the pharmacotherapy they are using. They are then asked to compare their own experiences.    2.6.1  Monitor side-effects caused by pharmacotherapy  A1, A4, BS1, BS5, BS6, RC8  1.6, 1.7, 2.4, 11.1  Missions, reminders, feed posts  The user is asked to monitor side-effects of pharmacotherapy regularly.    2.7.2  Modifies use of pharmacotherapy if inappropriate  BS1–BS4, A1  1.2, 1.5, 1.7, 11.1  Missions, reminders, feed posts  The user is prompted to revisit use of pharmacotherapy and talk to a health professional if the pharmacotherapy does not lead to desired result.  Outcome 3: Smoker utilizes social support network  TDF  PO  Change objectives  Smoking BCT  BCT  Practical applications  Content of practical application  Knowledge  3.1  Describes beneficial aspects of social support in quit attempt  A2, BM5  3.1  Educational videos and text , feed posts, social network  The user will be exposed to educational videos and text on the role of social support in the ability to quit, and is asked to engage the social network to ask about positive experiences of other users.  3.2  Defines high- risk relapse situations  A2, BM5, BS1, BS2, BS10, BS11  3.1, 4.2  Educational videos and text, feed posts  The user will be asked to define personal high- risk situations in which relapse is expected and when social support may be beneficial. Videos and text with examples are provided and the social network is consulted.  3.2  Understands effect of withdrawal effects and cravings on ability to quit  A2, BM5, BS1, RC6  3.1, 4.2, 5.1  Educational videos and text, feed posts  The user will get to view educational videos and text on the role of cravings and withdrawal, and how social support may be able to help deal with them. The social network is engaged.  Skills    Demonstrates ability to    3.3  - discuss extent of social support with social actor  A2, BS2, BS3  3.1, 4.1, 6.1, 8.1, 15.2  Educational videos, missions, feed posts, social network  The user will receive tips and tricks on how to best utilize the social network. The smoker needs to form a strategy (e.g., by forming implementation intentions) to their social support, and is asked to mentally rehearse how to do it.  3.4  - recognize need for social support  A2, BS1, BS2, BS3, RI3  1.2, 1.3, 1.4, 3.1, 8.1  Educational videos, missions, feed posts, social network  The user will be asked to review scenarios that may have warranted social support in the past and current smoking cessation attempt. The app will warn when potential triggers occur.  3.5.2  Demonstrates ability to discuss social actors support role and performance  A2, BS2, BS3, BS5  3.1, 4.1, 6.1, 8.1  Educational videos, missions, feed posts  Scenarios in which the social support network was inadequate are presented and potential solutions are given.  Beliefs about capabilities  3.1  Expresses positive attitude to using social support in attempt  A2, BM2  3.1, 15.1–15.4  Motivational videos and text, missions, feed posts, social network  Positive information on the use of social support is presented, including real- life examples of other users. Social actors are approached by the app to take initiative.      Demonstrates confidence      3.3  - to talk about quit smoking attempt with social actor  A2, BM2  3.1, 15.1–15.4  Motivational videos and text, missions, feed posts, social network  Positive information on the use of social support is presented, including real- life examples of other users. Social actors are approached by the app to take initiative.    3.5.2  - in discussing social actors support role and performance  A2, BM2  3.1 ,15.1–15.4  Motivational videos and text, missions, feed posts, social network  Positive information on the use of social support is presented, including real- life examples of other users. Social actors are approached by the app to take initiative.  Behavioral regulation  3.3  Identifies social actors of interest  A2, BS3  1.4, 3.1  Suggestions for friends from other social networks, social network, missions  The user will be asked to select friends to join them on Kick.it and outside of Kick.it (for those not tech savvy). The app will give suggestions based on contacts from other social networks.  3.3  Determines (extent of) social support role with social actor  A2, BM6, BS3, RC9  1.4, 1.8, 1.9, 3.1  Missions, feed posts  The user is asked to specify the extent of support each actor will give, for instance the support of the spouse is most probably more intense than the role of a colleague at work. The rules will be set in a contract to force commitment.  3.4  Contacts social support network according to social support rules  A2, BS3, RC9  3.1, 7.1, 8.3  Prompts, feed posts, Kick Stack, social network, missions  The user will be reminded to participate in social network on regular intervals. Smoker is prompted via Kick Stack, and social actor is contacted regularly to engage with user.  3.5  Recalls social support rules and roles  A2, BS1  1.5, 2.3, 3.1  Missions, feed posts  The user will be reminded to actively recall social support rules in their missions.  3.5.1  Recognize unsupportive social actors  A2, BS1, BS5, RC8  1.2, 1.5, 1.6, 1.7, 3.1  Missions, feed posts  Smoker will be prompted to review the social support rules and recognize which social actor is performing well and which one is not.  3.5.2  Changes social support network if deemed necessary  A2, BS1–BS4  1.2, 1.5, 1.7, 3.1  Missions, reminders, feed posts  The user is prompted to change the support actors if they do not deliver up to expectations.  Outcome 4: Smoker resumes quit attempt as soon as possible after slip-up or relapse  TDF  Change objectives  Smoking BCT  BCT  Practical applications  Content of practical application  Knowledge    Demonstrates understanding of      4.1  - common causes of slip-ups and relapse  BM1, BS1  4.2, 5.1  Educational videos and text, feed posts, social network  The user will be able to view educational videos and texts on common reasons that lead to relapse and slip-ups, what to look for and what to avoid. The social network is engaged.    4.2  - difference between slip and relapse  BM1  1.2  Feed posts, social network  The user will view information on the difference between slip-ups and relapsing and is asked to share their own thoughts in the social network.    4.3  - advantages of resuming quit attempt as soon as possible  BM1  5.1  Educational videos and text, feed posts  The user will be presented with facts of the health consequences of resuming smoking cessation and the difficulty that can be expected if they allow their nicotine dependence to return. Remind of pros of smoking cessation.    4.5.2  - strategies to counteract cause of slip-up  BM1, BS1, BS2  4.1  Educational videos and text, feed posts, missions  The user is reminded of high-risk situations and is presented with potential solutions to dealing with these situations. Own views are elicited. They are then asked to formulate their own plan to dealing with potential problematic situations.    4.5.1  Recalls information on effective ways to improve success rate of smoking cessation  A1, A2, BM1, BS3  4.1, 11.1, 11.2, 11.3, 12.1–12.5  Educational videos and text, feed posts, Kick Stack  The user is presented with a recap of the information on effect ways to quit smoking, the use of social support, pharmacotherapy, and the importance of a quit strategy.  Skills  4.1  Demonstrates ability to determine true cause of slip-up  BS1, BS2  1.2, 4.4  Feed posts, push notifications  The user is prompted to analyze the reasons for the slip-up to further understanding of abilities to improve future cessation attempts. Examples are provided to stimulate explanation.  4.5.2  Develops behavioral capacity to counteract cause of current slip-up  BS1, BS2  1.4, 4.1  Prompt after logging smoke, feed post, social network  The smoker is prompted to analyze behaviour and asked to develop strategies to counteract the slip-up in future cases. The social network is utilized.  Beliefs about capabil ities    Expresses positive attitude to    4.3  - reviewing slip-up  BM2  15.1–15.4  Motivational text and video, feed, social network  The user is presented with motivational text to ensure that they review the slip-up. Furthermore, the smoker is asked to interpret the slip-up each time they log a smoke.  4.4  - resuming smoking cessation  BM2  15.1–15.4  Motivational text and video, feed, social network  The user is prompted to restart smoking cessation by motivational texts. The social network is prompted to encourage the user.  4.5  - (revised) smoking cessation strategy  BM2  15.1–15.4  Motivational text and video, feed, social network  The user is presented with positive information regarding their new quit strategy.  4.4  Demonstrates confidence in ability to resume smoking cessation attempt  BM2  15.1–15.4  Motivational text and video, feed, social network  The user is presented with positive motivation based on current quit attempt and framing the message. The social network is prompted to encourage the user.  Behavioral regulation  4.2  Defines personal definition of slip-up versus relapse  BS4  1.4  Missions, reminders, feed posts, social network  The smoker needs to state their own definition of a slip-up and compare this with accepted definitions.    4.3  Assesses current slip-up/ relapse  BS1, BS2  1.2, 2.3  Log smoke button, feed posts  The smoker is able to log cigarettes smoked while still remaining on the quit attempt.    4.4  Plans to recommence quit smoking after slipping up  BS3  1.1, 1.4  Reminders, missions, social network  The smoker is asked to for implementation intentions to ensure recommencement of smoking after slip or relapse. Social network is used to help enable plan.    4.4  Reaffirms nonsmoker identity  BM8  13.5, 15.4  Reminders, feed posts, missions  The smoker is prompted throughout the quit attempts to keep believing and re-affirming in nonsmoking identity.    4.5  Recalls chosen quit strategy  BS1  1.5  Missions, feed posts  The user will be reminded to actively recall the quit strategy.    4.5.1  Reviews quit strategy at regular intervals  BS1, BS5, BS6, RC8  1.2, 1.5, 1.7, 2.3, 2.4  Missions, feed posts  The user will be prompted to review the quit strategy and recognize which elements are and which are not working for them.    4.5.1  Recognizes ineffective elements  BS1, BS5, RC8  1.2, 1.5, 1.6, 1.7  Missions, feed posts  The user will be prompted to review the quit strategy and recognize which elements are and which are not working for them.    4.5.2  Modifies quit strategy if strategy does not work according to expectations  BS1–BS4  1.2, 1.5, 1.7  Missions, feed posts  The user is prompted to change ineffective elements of the quit strategy for the next quit attempt.  Outcome 5: Social environment provides support during the smokers’ cessation attempt  TDF  PO  Change objectives  Smoking BCT  BCT  Practical applications  Content of practical application  Knowledge    Social actor develops understanding of    5.1  - physical and psychological consequences of smoking cessation  BM1, BM5, RC6  3.1, 4.2, 5.1  Educational videos and text, discussion in social network  The social actor will receive information on physical and mental consequences of smoking cessation, if and when they occur and what smokers need to do when they happen.  5.2  - the role of the social environment in smoking (cessation)  A2, BM5, BS1, BS2, BS11  3.1, 4.2, 5.3  Educational videos and text, discussion in social network  The social actor will learn about the positive effects of social support and the potential negative consequences of peer pressure, as well as how the social support has helped other users on Kick.it.  5.2  - evidence-based smoking cessation support methods  A1, BM5, BS2  3.1, 4.1, 5.1, 6.1, 11.1  Educational videos and text, discussion in social network  The social actor will receive information on all different kinds of pharmaceutical and behavioral methods and will learn about positive effects as well as potential side-effects.  5.2  - the importance of and suggestions for a planned quit strategy  BM5,BS1, BS2, BS7, BS8, BS10, BS11  3.1, 4.2, 11.2, 11.3, 12.1– 12.6  Educational videos and text, discussion in social network  The social actor will learn about effective strategies to increase self-control and what smokers can do to increase the chances of success (e.g., limit ego depletion, change routine, and limit cue exposure).  5.3  - ways to provide social support  A2  3.1, 4.1, 6.3  Educational videos and text, discussion in social network  The social actor is given examples of how to provide social support and is prompted to visit the feed and ask other supporters about tips and tricks.  5.2  Social actor distinguishes lay smoking and smoking cessation knowledge from factual knowledge  BM1, RC8, R13  3.1, 4.2, 5.1  Educational videos and text  The social actor will get information on common myths and is asked to compare their own experiences with facts (e.g., cigarettes and stress).  Skills    Social actor demonstrates    5.4  - ability discuss extent of social support with smoker  BS2, BS3, A2  3.1, 4.1, 6.1, 8.1  Educational videos and text, feed posts, social network  The social actor is asked to practice talking to smoker about their quit attempt. Educational videos and text with models are provided.  5.5  - interpersonal skills to provide social support  BS2, BS3, A2  3.1, 4.1, 6.1, 8.1  Educational videos and text, feed posts, social network  The social actor is asked to reflect on previous attempts of social support, in smoking and other areas, and translate that into current attempt. This is supported by modelling videos.  5.5.2  - ability to discuss issues in smoking cessation attempt  BS2, BS3, A2  3.1, 4.1, 6.1, 8.1  Educational videos and text, feed posts, social network  The social actor is asked to reflect on previous attempts of social support, in smoking and other areas, and translate that into current attempt. This is supported by modelling videos.  5.6  - ability to reflect on own performance as social support  A2  3.1, 4.1, 6.1, 8.1  Educational videos and text, feed posts, social network  The actor is asked to reflect on previous attempts of social support and translate that into current attempt. This is supported by educational videos.      Social actor expresses positive attitudes    Beliefs about capabilities  5.1  - to provide social support in quit attempt  A2, BM2  3.1, 13.1, 13.4, 15.1– 15.4  Motivational texts and videos, social network  The supporter is affirmed on their qualities as a supporter and is stimulated to see themselves as a role model to influence others on the platform.  5.2  - toward learning about support methods  A2, BM2  3.1, 15.1– 15.4  Motivational texts and videos, social network  The supporter is prompted with motivational text and is asked to make comparisons with other successful attempts at learning similar behaviors.  5.3  - toward learning about ways to provide support  A2, BM2  3.1, 15.1– 15.4  Motivational texts and videos, social network  The supporter is prompted with motivational text and is asked to make comparisons with other successful attempts at social support using analogies.  5.5  Social actor demonstrates confidence in providing social support during cessation attempt  A2, BM2  3.1, 15.1– 15.4  Motivational texts and videos, social network  The supporter is prompted with motivational text and is asked to make comparisons with other successful attempts at social support using analogies.  Behavioral regulation  5.5  Social actor plans social support role for smoking cessation attempt  A2, BS3  1.1, 1.4, 3.1  Videos and text, prompts  The social actor is prompted to plan their support attempt and ensure they have enough free time to check up on smoker.    5.5.1  Social actor monitors smoking cessation progress of the smoker  A2, BS5  2.1, 3.1  Videos and text, prompts  The social actor is prompted to monitor their support attempt and ensure they have enough free time to check up on smoker.    5.6  Social actor recalls social support agreement  A2, BS1,BS5  1.5, 3.1  Videos and text, prompts  The social actor is prompted to review their agreement and performance.    5.6.1  Social actor reviews social support roles  A2, BS1, BS5, RC8  1.2, 1.5, 1.7, 2.3, 2.4, 3.1  Videos and text, prompts  The social actor is prompted to review their agreement and performance.    5.6.1  Social actor recognizes ineffective elements of their support strategy  A2, BS1, BS5, RC8  1.2, 1.5, 1.6, 1.7, 3.1  Missions, feed posts  The social actor evaluates their own support role and recognized ineffective elements.    5.6.2  Social actor modifies support strategy if inappropriate  A2, BS1–BS4  1.2, 1.5, 1.6, 1.7, 3.1  Videos and text, prompts  The social actor is prompted to change their agreement and performance based on assessment.  Behavioral outcome 1: Smoker develops a personal quit strategy after downloading Kick.it  TDF  PO  Change objectives  Smoking BCT  BCT  Practical applications  Content of practical application  Knowledge    Demonstrates understanding of    1.1  - withdrawal effects associated with smoking cessation  BM1, BM5, RC6  4.2, 5.1  Educational videos and text, discussion in social network  The user will be presented with information on withdrawal effects, what they are, what to expect, and how long they last. Other users share their own experiences on the social platform.  1.1  - the role of cravings in smoking (cessation)  BM1, BM5  4.2, 5.1  Educational videos and text, discussion in social network  The user will learn what cravings are, what to expect in the short and the long term, and how long they last. Other users share their own experiences on the social platform.  1.1  - the role of the social environment in smoking (cessation)  A2, BS11, BM5  3.1, 4.2, 5.3  Educational videos and text, discussion in social network  The user will learn about the positive effects of social support and the potential negative consequences of peer pressure, as well as how it helped other users.  1.1  - physical and psychological consequences of smoking cessation  BM1, BM5  5.1, 9.2  Educational videos and text, discussion in social network  The user will receive information on physical and mental consequences of smoking cessation, if and when they occur and what to do when they happen. They will be asked to determine pros and cons of smoking cessation. Other users share their own experiences on the social platform.  1.2  - evidence-based smoking cessation support methods  A1, A5, BM5  4.1, 5.1, 6.1, 11.1  Educational videos and text, discussion in social network  The user will receive information on all different kinds of pharmaceutical and behavioural methods and will learn about positive effects as well as potential side-effects to monitor and what to do when they happen. Other users share their own experiences on the social platform.  1.3  - effective self-control strategies to aid in smoking cessation  BM5,BS1, BS2, BS7, BS8, BS10, BS11  4.2, 11.2, 11.3, 12.1–12.6  Educational videos and text, discussion in social network  The user will learn about effective strategies to increase self-control and what to do to increase the chances of success (e.g., limit ego depletion, change routine, limit cue exposure, self-affirmation). Other users share their own experiences on the social platform.  1.3  - the role of 5D’s in quit attempt  A1, A2, BM1, BS2  3.1, 4.2, 6.1, 11.1, 12.4  Educational videos and text, discussion in social network  The user will get education on 5D’s (Drink water, Deep breathe, Do something Else, Delay, and Discuss with social support) and why they can help deal with cravings. Other users share their own experiences on the social platform.    Distinguish between    1.1  - facts on smoking (cessation) from lay (mis) perceptions  BM1, RC8, R13  4.2, 5.1  Educational videos and text  The user will get information on common myths and is asked to compare their own experiences with facts (e.g., cigarettes and stress).  1.2  - lay (mis)perceptions about evidence-based support methods from facts  A1, BM1, RC8, R13  4.1, 5.1, 11.1  Educational videos and text  The user is asked to view a video or read a text about various factors associated with smoking cessation (e.g., pharmacotherapy use) and is then asked to compare their own experience with the information provided in the video/text.      Demonstrates ability to    Skills  1.5  - use pharmacotherapy according to prescription (if selected)  A1, BS2, BS3  1.4, 4.1, 6.1, 7.1, 8.3, 11.1  Educational video and text, reminders, logging of medication use, reminders  The smoker will view information that explains how to properly use pharmacotherapy. They can log their medication intake and craving pattern, and prompts and cues will be given to remind them to use the medication consistently.  1.5  - use of the 5D’s when craving  BS2, BS3  1.4, 4.1, 6.1, 7.1, 8.2, 8.3  Kick Stack, Educational video and text, reminders  After logging each smoke and crave, the smoker will be presented with random suggestions of 5D’s. Social support is facilitated via the social network.  1.5  - contact social actors according to social support rules  A2, BS2, BS3  1.4, 3.1, 7.1  Social network, reminders, Educational video and text  The user has access to social support network on the app. They furthermore receive reminders and prompts to utilize social network when needed (e.g., when cravings or withdrawal symptoms are strong). Videos and text are given that provide examples on how to broach the topic with social actors.  1.5  - implement self-control strategies before and during quit attempt  A5, BS2, BS3, BS7–BS11  1.2, 1.4, 3.1, 6.1, 7.1, 11.2, 11.3, 12.1–12.6  Educational videos and text, reminders, missions  The user can complete daily missions that aim to ensure they stick to the self-control strategy. Reminders are given repeatedly.  Beliefs about capabilities    Demonstrates confidence    1.1  - toward successfully quitting smoking  BM2, BM3, BM8, RC10, RI2  2.2, 13.4, 13.5, 15.1–15.4  Missions, feed posts, health and money feedback, social support, normative feedback  The user is reminded of ex-smoking identity, is motivated throughout and reminded of personal strength (e.g., via self-affirmation). Normative information on other smokers is provided as reference point. Health feedback and feedback of supporters are used to boost motivation further.  1.4  - that chosen smoking cessation strategy will be optimal solution for quit attempt  BM2, RD2, RI2  2.2, 15.1–15.4  Missions, feed posts, social network  The user is asked to actively think about the chosen quit strategy before the quit attempt to ensure it is the most optimal solution at the time. Choice is emphasized. The social network is prompted to provide supportive messages.  1.5  - in successfully executing chosen quit smoking strategy  BM2, RD2, RI2  2.2, 13.5, 15.1–15.4  Missions, feed posts, social network  The user is asked to commit to a quit strategy and to visualize the strategy working in the quit attempt. The social network is prompted to provide supportive messages.    Expresses positive attitudes    1.2  - toward using evidence-based support methods  BM2, BM5, RD2  6.3, 15.1–15.4  Prompts, feed posts, health and money feedback, social support, normative feedback, feed posts  The user is reminded of success rate of evidence-based support and coping models are used to bolster efficacy. Information on side-effects is provided. Normative information on other smokers is provided as reference point. Smoker is asked to visualize performing the behavior.  1.6.2  - toward changing quit smoking strategy if strategy is not working according to expectations  BM2, RD2  15.1–15.4  Missions, feed posts  The user will be prompted to (imagine) changing their quit smoking strategy if it is not appropriate or leads to undesirable results.  Behavioral regulation  1.4  Identifies effective strategies from past quit attempts  RI1, RI3  15.3  Missions, feed posts  The user is asked to evaluate previous quit attempts to see what worked and what did not.  1.4  Summarizes selected quit strategy  BS3, BS4, RC9  1.1, 1.3, 1.9  Missions, feed posts  The user is asked to repeat the quit strategy and its components (e.g., implementation intentions for dealing with high-risk situations) and determine the eventual treatment goals.  1.4  Commits to executing quit strategy  BM6  1.8, 1.9  Missions, feed posts, export to social media  The user is prompted to share the quit date and its components on Kick.it and social media.  1.5  Monitors withdrawal symptoms after quitting cigarettes  A4, BS6, RI4  2.4  Missions, feed posts  The user is reminded to monitor withdrawal symptoms and to contact a health professional if the symptoms get too much  1.5  Monitors craving pattern to understand quit smoking attempt  BS6  2.1, 2.4  Craving feedback, feed posts  The user can monitor the craving pattern via the app, based on the logged data, and is asked to actively monitor for potential trigger to avoid.  1.5  Affirms nonsmoking identity  BM8  13.5  Missions, feed posts, social network  The user is asked to construct a nonsmoking identity at multiple occasions (e.g., on social network and via missions)  1.6  Recalls chosen quit strategy  BS1  1.5  Missions, feed posts  The user is prompted to recall the quit strategy via the missions to identify what works and what does not.  1.6.1  Reviews quit strategy at regular intervals  BS1, BS5, BS6, RC8  1.2, 1.5, 1.7, 2.3, 2.4  Missions, feed posts  The user is prompted to actively review elements of the quit attempt to see what works and what does not.  1.6.1  Recognizes ineffective elements  BS1, BS5, RC8  1.2, 1.5, 1.6, 1.7  Missions, feed posts  The user is prompted to actively review elements of the quit attempt.  1.6.2  Modifies quit strategy if strategy does not work according to expectations  BS1–BS4  1.2, 1.5, 1.7  Missions, feed posts  The user is prompted to change ineffective elements of the quit strategy if necessary.  Outcome 2: Smoker adheres to pharmacotherapy treatment plan  TDF  PO  Change objectives  Smoking BCT  BCT  Practical applications  Content of practical application  Knowledge    Increases understanding of      2.1  - side-effects of smoking cessation pharmacotherapy  BM5, A1, A4  5.1, 6.2, 11.1  Educational videos and text, feed posts, social network  The user is presented with information explaining potential side-effects and what to look for. Their personal experiences are explored and the social network is engaged.    2.1  - beneficial effects of smoking cessation pharmacotherapy  BM5, A1, A4  5.1, 6.2, 11.1  Educational videos and text, feed posts, social network  The user is presented with information explaining beneficial effects of pharmacotherapy. Their personal experiences are explored and the social network is engaged.    2.2  - potential pharmacotherapy options  BM5, A1, A4  6.2, 11.1  Educational videos and text, medication list  The user is presented with educational content on pharmacotherapy. The social network is prompted to share experiences.    2.4  - exact treatment protocol of pharmacotherapy  A1  4.1, 11.1  Educational videos and text  The user will be able to read education information or watch videos explaining how to use each individual product and why they have to stick to the treatment regimen.  Skills  2.3  Acquires pharmacotherapy  A1, A3  4.1, 6.1, 11.1  Instructional videos and text, potential order button/link- out via Kick.it  The user receives information on where to get pharmacotherapy and what the potential costs are.  2.5  Demonstrates ability to use pharmacotherapy at correct dose and at correct interval  A1  4.1, 6.1, 7.1 , 11.1  Instructional videos and text, reminders, Kick Stack, CareCard, feed posts  The user will be able to read education information or watch videos explaining how to use each individual product. Furthermore, the app will give reminders to education on use of product and prompt review of its effects.  Beliefs about capabilities  2.1  Alters lay perceptions on pharmacotherapy if needed  A1, RC8, RI3  11.1, 15.3  Motivational text and video, feed, social network  The user is asked to compare factual information with lay experiences or information received from other lay sources, myths are debunked.    Demonstrates confidence    2.5  - in using pharmaceutical support according to treatment protocol  A1, BM2  11.1, 15.1–15.4  Motivational text and video, feed, social network, reminders  The user is presented with motivational text and videos. The social network is utilized to further bolster support. Reminders help them stay on track.  2.6.1  - to approach health professional in case of problems with pharmacotherapy solution  A1, BM2  11.1, 15.1–15.4  Motivational text and video, feed posts  The user is provided motivational content that aims to bolster confidence to broach medication with their health professional. Health professionals will feature in videos.  2.6.1  - to approach health professional in case of problems with pharmacotherapy solution  A1, BM2  11.1, 15.1–15.4  Motivational text and video, feed posts  The user is provided motivational content that aims to bolster confidence to broach medication with their health professional. Health professionals will feature in videos.    Expresses positive attitudes    2.1  - toward using pharmaceutical support  A1, BM2  11.1, 15.1–15.4  Motivational text and video, feed, social network  The user is provided motivational facts and videos on how pharmacotherapy will help them and has helped millions of other smokers. Other smokers are asked to share their positive experiences.  2.6.2  - toward changing pharmacotherapy if desired effect is not reached  A1, BM2  11.1, 15.1–15.4  Motivational text and video, feed, social network  The user can view information that informs changing treatment regimens is necessary for optimal results.  Behavioral regulation  2.4  Ensures to have sufficient quantity of pharmacotherapy at start of quit attempt  A1, BS3  1.4, 11.1  Missions, reminders, feed posts, social network  The user is on multiple occasions reminder to ensure to have enough product in possession. Social network is asked to verify.    2.5  Recognizes mental/ physical symptoms that trigger need for pharmacotherapy  A1, BS1  1.2, 11.1  Missions, reminders, feed posts, log a crave  The user is reminded to monitor physical and emotional symptoms that may trigger need for use of pharmacotherapy. Suggestions will be made based on cravings logged.    2.6  Recalls treatment protocol of pharmacotherapy of choice  A1, BS1  1.5, 2.3, 11.1  Missions, reminders, feed posts, CareCard  The user is prompted to review the use of pharmacotherapy in missions and in regular feed posts. CareCard may prompt treatment as well.    2.6.1  Compare expected effect of pharmacotherapy with own experience  A1, A4, BS1, BS5, BS6, RC8  1.6, 1.7, 2.4, 11.1  Missions, reminders, feed posts, CareCard  The user is reminder of information about the positive and negative effects of the pharmacotherapy they are using. They are then asked to compare their own experiences.    2.6.1  Monitor side-effects caused by pharmacotherapy  A1, A4, BS1, BS5, BS6, RC8  1.6, 1.7, 2.4, 11.1  Missions, reminders, feed posts  The user is asked to monitor side-effects of pharmacotherapy regularly.    2.7.2  Modifies use of pharmacotherapy if inappropriate  BS1–BS4, A1  1.2, 1.5, 1.7, 11.1  Missions, reminders, feed posts  The user is prompted to revisit use of pharmacotherapy and talk to a health professional if the pharmacotherapy does not lead to desired result.  Outcome 3: Smoker utilizes social support network  TDF  PO  Change objectives  Smoking BCT  BCT  Practical applications  Content of practical application  Knowledge  3.1  Describes beneficial aspects of social support in quit attempt  A2, BM5  3.1  Educational videos and text , feed posts, social network  The user will be exposed to educational videos and text on the role of social support in the ability to quit, and is asked to engage the social network to ask about positive experiences of other users.  3.2  Defines high- risk relapse situations  A2, BM5, BS1, BS2, BS10, BS11  3.1, 4.2  Educational videos and text, feed posts  The user will be asked to define personal high- risk situations in which relapse is expected and when social support may be beneficial. Videos and text with examples are provided and the social network is consulted.  3.2  Understands effect of withdrawal effects and cravings on ability to quit  A2, BM5, BS1, RC6  3.1, 4.2, 5.1  Educational videos and text, feed posts  The user will get to view educational videos and text on the role of cravings and withdrawal, and how social support may be able to help deal with them. The social network is engaged.  Skills    Demonstrates ability to    3.3  - discuss extent of social support with social actor  A2, BS2, BS3  3.1, 4.1, 6.1, 8.1, 15.2  Educational videos, missions, feed posts, social network  The user will receive tips and tricks on how to best utilize the social network. The smoker needs to form a strategy (e.g., by forming implementation intentions) to their social support, and is asked to mentally rehearse how to do it.  3.4  - recognize need for social support  A2, BS1, BS2, BS3, RI3  1.2, 1.3, 1.4, 3.1, 8.1  Educational videos, missions, feed posts, social network  The user will be asked to review scenarios that may have warranted social support in the past and current smoking cessation attempt. The app will warn when potential triggers occur.  3.5.2  Demonstrates ability to discuss social actors support role and performance  A2, BS2, BS3, BS5  3.1, 4.1, 6.1, 8.1  Educational videos, missions, feed posts  Scenarios in which the social support network was inadequate are presented and potential solutions are given.  Beliefs about capabilities  3.1  Expresses positive attitude to using social support in attempt  A2, BM2  3.1, 15.1–15.4  Motivational videos and text, missions, feed posts, social network  Positive information on the use of social support is presented, including real- life examples of other users. Social actors are approached by the app to take initiative.      Demonstrates confidence      3.3  - to talk about quit smoking attempt with social actor  A2, BM2  3.1, 15.1–15.4  Motivational videos and text, missions, feed posts, social network  Positive information on the use of social support is presented, including real- life examples of other users. Social actors are approached by the app to take initiative.    3.5.2  - in discussing social actors support role and performance  A2, BM2  3.1 ,15.1–15.4  Motivational videos and text, missions, feed posts, social network  Positive information on the use of social support is presented, including real- life examples of other users. Social actors are approached by the app to take initiative.  Behavioral regulation  3.3  Identifies social actors of interest  A2, BS3  1.4, 3.1  Suggestions for friends from other social networks, social network, missions  The user will be asked to select friends to join them on Kick.it and outside of Kick.it (for those not tech savvy). The app will give suggestions based on contacts from other social networks.  3.3  Determines (extent of) social support role with social actor  A2, BM6, BS3, RC9  1.4, 1.8, 1.9, 3.1  Missions, feed posts  The user is asked to specify the extent of support each actor will give, for instance the support of the spouse is most probably more intense than the role of a colleague at work. The rules will be set in a contract to force commitment.  3.4  Contacts social support network according to social support rules  A2, BS3, RC9  3.1, 7.1, 8.3  Prompts, feed posts, Kick Stack, social network, missions  The user will be reminded to participate in social network on regular intervals. Smoker is prompted via Kick Stack, and social actor is contacted regularly to engage with user.  3.5  Recalls social support rules and roles  A2, BS1  1.5, 2.3, 3.1  Missions, feed posts  The user will be reminded to actively recall social support rules in their missions.  3.5.1  Recognize unsupportive social actors  A2, BS1, BS5, RC8  1.2, 1.5, 1.6, 1.7, 3.1  Missions, feed posts  Smoker will be prompted to review the social support rules and recognize which social actor is performing well and which one is not.  3.5.2  Changes social support network if deemed necessary  A2, BS1–BS4  1.2, 1.5, 1.7, 3.1  Missions, reminders, feed posts  The user is prompted to change the support actors if they do not deliver up to expectations.  Outcome 4: Smoker resumes quit attempt as soon as possible after slip-up or relapse  TDF  Change objectives  Smoking BCT  BCT  Practical applications  Content of practical application  Knowledge    Demonstrates understanding of      4.1  - common causes of slip-ups and relapse  BM1, BS1  4.2, 5.1  Educational videos and text, feed posts, social network  The user will be able to view educational videos and texts on common reasons that lead to relapse and slip-ups, what to look for and what to avoid. The social network is engaged.    4.2  - difference between slip and relapse  BM1  1.2  Feed posts, social network  The user will view information on the difference between slip-ups and relapsing and is asked to share their own thoughts in the social network.    4.3  - advantages of resuming quit attempt as soon as possible  BM1  5.1  Educational videos and text, feed posts  The user will be presented with facts of the health consequences of resuming smoking cessation and the difficulty that can be expected if they allow their nicotine dependence to return. Remind of pros of smoking cessation.    4.5.2  - strategies to counteract cause of slip-up  BM1, BS1, BS2  4.1  Educational videos and text, feed posts, missions  The user is reminded of high-risk situations and is presented with potential solutions to dealing with these situations. Own views are elicited. They are then asked to formulate their own plan to dealing with potential problematic situations.    4.5.1  Recalls information on effective ways to improve success rate of smoking cessation  A1, A2, BM1, BS3  4.1, 11.1, 11.2, 11.3, 12.1–12.5  Educational videos and text, feed posts, Kick Stack  The user is presented with a recap of the information on effect ways to quit smoking, the use of social support, pharmacotherapy, and the importance of a quit strategy.  Skills  4.1  Demonstrates ability to determine true cause of slip-up  BS1, BS2  1.2, 4.4  Feed posts, push notifications  The user is prompted to analyze the reasons for the slip-up to further understanding of abilities to improve future cessation attempts. Examples are provided to stimulate explanation.  4.5.2  Develops behavioral capacity to counteract cause of current slip-up  BS1, BS2  1.4, 4.1  Prompt after logging smoke, feed post, social network  The smoker is prompted to analyze behaviour and asked to develop strategies to counteract the slip-up in future cases. The social network is utilized.  Beliefs about capabil ities    Expresses positive attitude to    4.3  - reviewing slip-up  BM2  15.1–15.4  Motivational text and video, feed, social network  The user is presented with motivational text to ensure that they review the slip-up. Furthermore, the smoker is asked to interpret the slip-up each time they log a smoke.  4.4  - resuming smoking cessation  BM2  15.1–15.4  Motivational text and video, feed, social network  The user is prompted to restart smoking cessation by motivational texts. The social network is prompted to encourage the user.  4.5  - (revised) smoking cessation strategy  BM2  15.1–15.4  Motivational text and video, feed, social network  The user is presented with positive information regarding their new quit strategy.  4.4  Demonstrates confidence in ability to resume smoking cessation attempt  BM2  15.1–15.4  Motivational text and video, feed, social network  The user is presented with positive motivation based on current quit attempt and framing the message. The social network is prompted to encourage the user.  Behavioral regulation  4.2  Defines personal definition of slip-up versus relapse  BS4  1.4  Missions, reminders, feed posts, social network  The smoker needs to state their own definition of a slip-up and compare this with accepted definitions.    4.3  Assesses current slip-up/ relapse  BS1, BS2  1.2, 2.3  Log smoke button, feed posts  The smoker is able to log cigarettes smoked while still remaining on the quit attempt.    4.4  Plans to recommence quit smoking after slipping up  BS3  1.1, 1.4  Reminders, missions, social network  The smoker is asked to for implementation intentions to ensure recommencement of smoking after slip or relapse. Social network is used to help enable plan.    4.4  Reaffirms nonsmoker identity  BM8  13.5, 15.4  Reminders, feed posts, missions  The smoker is prompted throughout the quit attempts to keep believing and re-affirming in nonsmoking identity.    4.5  Recalls chosen quit strategy  BS1  1.5  Missions, feed posts  The user will be reminded to actively recall the quit strategy.    4.5.1  Reviews quit strategy at regular intervals  BS1, BS5, BS6, RC8  1.2, 1.5, 1.7, 2.3, 2.4  Missions, feed posts  The user will be prompted to review the quit strategy and recognize which elements are and which are not working for them.    4.5.1  Recognizes ineffective elements  BS1, BS5, RC8  1.2, 1.5, 1.6, 1.7  Missions, feed posts  The user will be prompted to review the quit strategy and recognize which elements are and which are not working for them.    4.5.2  Modifies quit strategy if strategy does not work according to expectations  BS1–BS4  1.2, 1.5, 1.7  Missions, feed posts  The user is prompted to change ineffective elements of the quit strategy for the next quit attempt.  Outcome 5: Social environment provides support during the smokers’ cessation attempt  TDF  PO  Change objectives  Smoking BCT  BCT  Practical applications  Content of practical application  Knowledge    Social actor develops understanding of    5.1  - physical and psychological consequences of smoking cessation  BM1, BM5, RC6  3.1, 4.2, 5.1  Educational videos and text, discussion in social network  The social actor will receive information on physical and mental consequences of smoking cessation, if and when they occur and what smokers need to do when they happen.  5.2  - the role of the social environment in smoking (cessation)  A2, BM5, BS1, BS2, BS11  3.1, 4.2, 5.3  Educational videos and text, discussion in social network  The social actor will learn about the positive effects of social support and the potential negative consequences of peer pressure, as well as how the social support has helped other users on Kick.it.  5.2  - evidence-based smoking cessation support methods  A1, BM5, BS2  3.1, 4.1, 5.1, 6.1, 11.1  Educational videos and text, discussion in social network  The social actor will receive information on all different kinds of pharmaceutical and behavioral methods and will learn about positive effects as well as potential side-effects.  5.2  - the importance of and suggestions for a planned quit strategy  BM5,BS1, BS2, BS7, BS8, BS10, BS11  3.1, 4.2, 11.2, 11.3, 12.1– 12.6  Educational videos and text, discussion in social network  The social actor will learn about effective strategies to increase self-control and what smokers can do to increase the chances of success (e.g., limit ego depletion, change routine, and limit cue exposure).  5.3  - ways to provide social support  A2  3.1, 4.1, 6.3  Educational videos and text, discussion in social network  The social actor is given examples of how to provide social support and is prompted to visit the feed and ask other supporters about tips and tricks.  5.2  Social actor distinguishes lay smoking and smoking cessation knowledge from factual knowledge  BM1, RC8, R13  3.1, 4.2, 5.1  Educational videos and text  The social actor will get information on common myths and is asked to compare their own experiences with facts (e.g., cigarettes and stress).  Skills    Social actor demonstrates    5.4  - ability discuss extent of social support with smoker  BS2, BS3, A2  3.1, 4.1, 6.1, 8.1  Educational videos and text, feed posts, social network  The social actor is asked to practice talking to smoker about their quit attempt. Educational videos and text with models are provided.  5.5  - interpersonal skills to provide social support  BS2, BS3, A2  3.1, 4.1, 6.1, 8.1  Educational videos and text, feed posts, social network  The social actor is asked to reflect on previous attempts of social support, in smoking and other areas, and translate that into current attempt. This is supported by modelling videos.  5.5.2  - ability to discuss issues in smoking cessation attempt  BS2, BS3, A2  3.1, 4.1, 6.1, 8.1  Educational videos and text, feed posts, social network  The social actor is asked to reflect on previous attempts of social support, in smoking and other areas, and translate that into current attempt. This is supported by modelling videos.  5.6  - ability to reflect on own performance as social support  A2  3.1, 4.1, 6.1, 8.1  Educational videos and text, feed posts, social network  The actor is asked to reflect on previous attempts of social support and translate that into current attempt. This is supported by educational videos.      Social actor expresses positive attitudes    Beliefs about capabilities  5.1  - to provide social support in quit attempt  A2, BM2  3.1, 13.1, 13.4, 15.1– 15.4  Motivational texts and videos, social network  The supporter is affirmed on their qualities as a supporter and is stimulated to see themselves as a role model to influence others on the platform.  5.2  - toward learning about support methods  A2, BM2  3.1, 15.1– 15.4  Motivational texts and videos, social network  The supporter is prompted with motivational text and is asked to make comparisons with other successful attempts at learning similar behaviors.  5.3  - toward learning about ways to provide support  A2, BM2  3.1, 15.1– 15.4  Motivational texts and videos, social network  The supporter is prompted with motivational text and is asked to make comparisons with other successful attempts at social support using analogies.  5.5  Social actor demonstrates confidence in providing social support during cessation attempt  A2, BM2  3.1, 15.1– 15.4  Motivational texts and videos, social network  The supporter is prompted with motivational text and is asked to make comparisons with other successful attempts at social support using analogies.  Behavioral regulation  5.5  Social actor plans social support role for smoking cessation attempt  A2, BS3  1.1, 1.4, 3.1  Videos and text, prompts  The social actor is prompted to plan their support attempt and ensure they have enough free time to check up on smoker.    5.5.1  Social actor monitors smoking cessation progress of the smoker  A2, BS5  2.1, 3.1  Videos and text, prompts  The social actor is prompted to monitor their support attempt and ensure they have enough free time to check up on smoker.    5.6  Social actor recalls social support agreement  A2, BS1,BS5  1.5, 3.1  Videos and text, prompts  The social actor is prompted to review their agreement and performance.    5.6.1  Social actor reviews social support roles  A2, BS1, BS5, RC8  1.2, 1.5, 1.7, 2.3, 2.4, 3.1  Videos and text, prompts  The social actor is prompted to review their agreement and performance.    5.6.1  Social actor recognizes ineffective elements of their support strategy  A2, BS1, BS5, RC8  1.2, 1.5, 1.6, 1.7, 3.1  Missions, feed posts  The social actor evaluates their own support role and recognized ineffective elements.    5.6.2  Social actor modifies support strategy if inappropriate  A2, BS1–BS4  1.2, 1.5, 1.6, 1.7, 3.1  Videos and text, prompts  The social actor is prompted to change their agreement and performance based on assessment.  Change objectives matched with the PO and TDF determinant they belong to. Each change objective is coded for evidence-based BCTs for smoking [26] and for general behavioral change [27]. They are then translated into practical applications. The final column describes the specific content of each practical application. PO performance objectives; TDF Theoretical domains Framework. View Large Table 2 Change objectives of Kick.it matched with evidence-based behavioral change techniques (BCTs) and practical applications in the app Behavioral outcome 1: Smoker develops a personal quit strategy after downloading Kick.it  TDF  PO  Change objectives  Smoking BCT  BCT  Practical applications  Content of practical application  Knowledge    Demonstrates understanding of    1.1  - withdrawal effects associated with smoking cessation  BM1, BM5, RC6  4.2, 5.1  Educational videos and text, discussion in social network  The user will be presented with information on withdrawal effects, what they are, what to expect, and how long they last. Other users share their own experiences on the social platform.  1.1  - the role of cravings in smoking (cessation)  BM1, BM5  4.2, 5.1  Educational videos and text, discussion in social network  The user will learn what cravings are, what to expect in the short and the long term, and how long they last. Other users share their own experiences on the social platform.  1.1  - the role of the social environment in smoking (cessation)  A2, BS11, BM5  3.1, 4.2, 5.3  Educational videos and text, discussion in social network  The user will learn about the positive effects of social support and the potential negative consequences of peer pressure, as well as how it helped other users.  1.1  - physical and psychological consequences of smoking cessation  BM1, BM5  5.1, 9.2  Educational videos and text, discussion in social network  The user will receive information on physical and mental consequences of smoking cessation, if and when they occur and what to do when they happen. They will be asked to determine pros and cons of smoking cessation. Other users share their own experiences on the social platform.  1.2  - evidence-based smoking cessation support methods  A1, A5, BM5  4.1, 5.1, 6.1, 11.1  Educational videos and text, discussion in social network  The user will receive information on all different kinds of pharmaceutical and behavioural methods and will learn about positive effects as well as potential side-effects to monitor and what to do when they happen. Other users share their own experiences on the social platform.  1.3  - effective self-control strategies to aid in smoking cessation  BM5,BS1, BS2, BS7, BS8, BS10, BS11  4.2, 11.2, 11.3, 12.1–12.6  Educational videos and text, discussion in social network  The user will learn about effective strategies to increase self-control and what to do to increase the chances of success (e.g., limit ego depletion, change routine, limit cue exposure, self-affirmation). Other users share their own experiences on the social platform.  1.3  - the role of 5D’s in quit attempt  A1, A2, BM1, BS2  3.1, 4.2, 6.1, 11.1, 12.4  Educational videos and text, discussion in social network  The user will get education on 5D’s (Drink water, Deep breathe, Do something Else, Delay, and Discuss with social support) and why they can help deal with cravings. Other users share their own experiences on the social platform.    Distinguish between    1.1  - facts on smoking (cessation) from lay (mis) perceptions  BM1, RC8, R13  4.2, 5.1  Educational videos and text  The user will get information on common myths and is asked to compare their own experiences with facts (e.g., cigarettes and stress).  1.2  - lay (mis)perceptions about evidence-based support methods from facts  A1, BM1, RC8, R13  4.1, 5.1, 11.1  Educational videos and text  The user is asked to view a video or read a text about various factors associated with smoking cessation (e.g., pharmacotherapy use) and is then asked to compare their own experience with the information provided in the video/text.      Demonstrates ability to    Skills  1.5  - use pharmacotherapy according to prescription (if selected)  A1, BS2, BS3  1.4, 4.1, 6.1, 7.1, 8.3, 11.1  Educational video and text, reminders, logging of medication use, reminders  The smoker will view information that explains how to properly use pharmacotherapy. They can log their medication intake and craving pattern, and prompts and cues will be given to remind them to use the medication consistently.  1.5  - use of the 5D’s when craving  BS2, BS3  1.4, 4.1, 6.1, 7.1, 8.2, 8.3  Kick Stack, Educational video and text, reminders  After logging each smoke and crave, the smoker will be presented with random suggestions of 5D’s. Social support is facilitated via the social network.  1.5  - contact social actors according to social support rules  A2, BS2, BS3  1.4, 3.1, 7.1  Social network, reminders, Educational video and text  The user has access to social support network on the app. They furthermore receive reminders and prompts to utilize social network when needed (e.g., when cravings or withdrawal symptoms are strong). Videos and text are given that provide examples on how to broach the topic with social actors.  1.5  - implement self-control strategies before and during quit attempt  A5, BS2, BS3, BS7–BS11  1.2, 1.4, 3.1, 6.1, 7.1, 11.2, 11.3, 12.1–12.6  Educational videos and text, reminders, missions  The user can complete daily missions that aim to ensure they stick to the self-control strategy. Reminders are given repeatedly.  Beliefs about capabilities    Demonstrates confidence    1.1  - toward successfully quitting smoking  BM2, BM3, BM8, RC10, RI2  2.2, 13.4, 13.5, 15.1–15.4  Missions, feed posts, health and money feedback, social support, normative feedback  The user is reminded of ex-smoking identity, is motivated throughout and reminded of personal strength (e.g., via self-affirmation). Normative information on other smokers is provided as reference point. Health feedback and feedback of supporters are used to boost motivation further.  1.4  - that chosen smoking cessation strategy will be optimal solution for quit attempt  BM2, RD2, RI2  2.2, 15.1–15.4  Missions, feed posts, social network  The user is asked to actively think about the chosen quit strategy before the quit attempt to ensure it is the most optimal solution at the time. Choice is emphasized. The social network is prompted to provide supportive messages.  1.5  - in successfully executing chosen quit smoking strategy  BM2, RD2, RI2  2.2, 13.5, 15.1–15.4  Missions, feed posts, social network  The user is asked to commit to a quit strategy and to visualize the strategy working in the quit attempt. The social network is prompted to provide supportive messages.    Expresses positive attitudes    1.2  - toward using evidence-based support methods  BM2, BM5, RD2  6.3, 15.1–15.4  Prompts, feed posts, health and money feedback, social support, normative feedback, feed posts  The user is reminded of success rate of evidence-based support and coping models are used to bolster efficacy. Information on side-effects is provided. Normative information on other smokers is provided as reference point. Smoker is asked to visualize performing the behavior.  1.6.2  - toward changing quit smoking strategy if strategy is not working according to expectations  BM2, RD2  15.1–15.4  Missions, feed posts  The user will be prompted to (imagine) changing their quit smoking strategy if it is not appropriate or leads to undesirable results.  Behavioral regulation  1.4  Identifies effective strategies from past quit attempts  RI1, RI3  15.3  Missions, feed posts  The user is asked to evaluate previous quit attempts to see what worked and what did not.  1.4  Summarizes selected quit strategy  BS3, BS4, RC9  1.1, 1.3, 1.9  Missions, feed posts  The user is asked to repeat the quit strategy and its components (e.g., implementation intentions for dealing with high-risk situations) and determine the eventual treatment goals.  1.4  Commits to executing quit strategy  BM6  1.8, 1.9  Missions, feed posts, export to social media  The user is prompted to share the quit date and its components on Kick.it and social media.  1.5  Monitors withdrawal symptoms after quitting cigarettes  A4, BS6, RI4  2.4  Missions, feed posts  The user is reminded to monitor withdrawal symptoms and to contact a health professional if the symptoms get too much  1.5  Monitors craving pattern to understand quit smoking attempt  BS6  2.1, 2.4  Craving feedback, feed posts  The user can monitor the craving pattern via the app, based on the logged data, and is asked to actively monitor for potential trigger to avoid.  1.5  Affirms nonsmoking identity  BM8  13.5  Missions, feed posts, social network  The user is asked to construct a nonsmoking identity at multiple occasions (e.g., on social network and via missions)  1.6  Recalls chosen quit strategy  BS1  1.5  Missions, feed posts  The user is prompted to recall the quit strategy via the missions to identify what works and what does not.  1.6.1  Reviews quit strategy at regular intervals  BS1, BS5, BS6, RC8  1.2, 1.5, 1.7, 2.3, 2.4  Missions, feed posts  The user is prompted to actively review elements of the quit attempt to see what works and what does not.  1.6.1  Recognizes ineffective elements  BS1, BS5, RC8  1.2, 1.5, 1.6, 1.7  Missions, feed posts  The user is prompted to actively review elements of the quit attempt.  1.6.2  Modifies quit strategy if strategy does not work according to expectations  BS1–BS4  1.2, 1.5, 1.7  Missions, feed posts  The user is prompted to change ineffective elements of the quit strategy if necessary.  Outcome 2: Smoker adheres to pharmacotherapy treatment plan  TDF  PO  Change objectives  Smoking BCT  BCT  Practical applications  Content of practical application  Knowledge    Increases understanding of      2.1  - side-effects of smoking cessation pharmacotherapy  BM5, A1, A4  5.1, 6.2, 11.1  Educational videos and text, feed posts, social network  The user is presented with information explaining potential side-effects and what to look for. Their personal experiences are explored and the social network is engaged.    2.1  - beneficial effects of smoking cessation pharmacotherapy  BM5, A1, A4  5.1, 6.2, 11.1  Educational videos and text, feed posts, social network  The user is presented with information explaining beneficial effects of pharmacotherapy. Their personal experiences are explored and the social network is engaged.    2.2  - potential pharmacotherapy options  BM5, A1, A4  6.2, 11.1  Educational videos and text, medication list  The user is presented with educational content on pharmacotherapy. The social network is prompted to share experiences.    2.4  - exact treatment protocol of pharmacotherapy  A1  4.1, 11.1  Educational videos and text  The user will be able to read education information or watch videos explaining how to use each individual product and why they have to stick to the treatment regimen.  Skills  2.3  Acquires pharmacotherapy  A1, A3  4.1, 6.1, 11.1  Instructional videos and text, potential order button/link- out via Kick.it  The user receives information on where to get pharmacotherapy and what the potential costs are.  2.5  Demonstrates ability to use pharmacotherapy at correct dose and at correct interval  A1  4.1, 6.1, 7.1 , 11.1  Instructional videos and text, reminders, Kick Stack, CareCard, feed posts  The user will be able to read education information or watch videos explaining how to use each individual product. Furthermore, the app will give reminders to education on use of product and prompt review of its effects.  Beliefs about capabilities  2.1  Alters lay perceptions on pharmacotherapy if needed  A1, RC8, RI3  11.1, 15.3  Motivational text and video, feed, social network  The user is asked to compare factual information with lay experiences or information received from other lay sources, myths are debunked.    Demonstrates confidence    2.5  - in using pharmaceutical support according to treatment protocol  A1, BM2  11.1, 15.1–15.4  Motivational text and video, feed, social network, reminders  The user is presented with motivational text and videos. The social network is utilized to further bolster support. Reminders help them stay on track.  2.6.1  - to approach health professional in case of problems with pharmacotherapy solution  A1, BM2  11.1, 15.1–15.4  Motivational text and video, feed posts  The user is provided motivational content that aims to bolster confidence to broach medication with their health professional. Health professionals will feature in videos.  2.6.1  - to approach health professional in case of problems with pharmacotherapy solution  A1, BM2  11.1, 15.1–15.4  Motivational text and video, feed posts  The user is provided motivational content that aims to bolster confidence to broach medication with their health professional. Health professionals will feature in videos.    Expresses positive attitudes    2.1  - toward using pharmaceutical support  A1, BM2  11.1, 15.1–15.4  Motivational text and video, feed, social network  The user is provided motivational facts and videos on how pharmacotherapy will help them and has helped millions of other smokers. Other smokers are asked to share their positive experiences.  2.6.2  - toward changing pharmacotherapy if desired effect is not reached  A1, BM2  11.1, 15.1–15.4  Motivational text and video, feed, social network  The user can view information that informs changing treatment regimens is necessary for optimal results.  Behavioral regulation  2.4  Ensures to have sufficient quantity of pharmacotherapy at start of quit attempt  A1, BS3  1.4, 11.1  Missions, reminders, feed posts, social network  The user is on multiple occasions reminder to ensure to have enough product in possession. Social network is asked to verify.    2.5  Recognizes mental/ physical symptoms that trigger need for pharmacotherapy  A1, BS1  1.2, 11.1  Missions, reminders, feed posts, log a crave  The user is reminded to monitor physical and emotional symptoms that may trigger need for use of pharmacotherapy. Suggestions will be made based on cravings logged.    2.6  Recalls treatment protocol of pharmacotherapy of choice  A1, BS1  1.5, 2.3, 11.1  Missions, reminders, feed posts, CareCard  The user is prompted to review the use of pharmacotherapy in missions and in regular feed posts. CareCard may prompt treatment as well.    2.6.1  Compare expected effect of pharmacotherapy with own experience  A1, A4, BS1, BS5, BS6, RC8  1.6, 1.7, 2.4, 11.1  Missions, reminders, feed posts, CareCard  The user is reminder of information about the positive and negative effects of the pharmacotherapy they are using. They are then asked to compare their own experiences.    2.6.1  Monitor side-effects caused by pharmacotherapy  A1, A4, BS1, BS5, BS6, RC8  1.6, 1.7, 2.4, 11.1  Missions, reminders, feed posts  The user is asked to monitor side-effects of pharmacotherapy regularly.    2.7.2  Modifies use of pharmacotherapy if inappropriate  BS1–BS4, A1  1.2, 1.5, 1.7, 11.1  Missions, reminders, feed posts  The user is prompted to revisit use of pharmacotherapy and talk to a health professional if the pharmacotherapy does not lead to desired result.  Outcome 3: Smoker utilizes social support network  TDF  PO  Change objectives  Smoking BCT  BCT  Practical applications  Content of practical application  Knowledge  3.1  Describes beneficial aspects of social support in quit attempt  A2, BM5  3.1  Educational videos and text , feed posts, social network  The user will be exposed to educational videos and text on the role of social support in the ability to quit, and is asked to engage the social network to ask about positive experiences of other users.  3.2  Defines high- risk relapse situations  A2, BM5, BS1, BS2, BS10, BS11  3.1, 4.2  Educational videos and text, feed posts  The user will be asked to define personal high- risk situations in which relapse is expected and when social support may be beneficial. Videos and text with examples are provided and the social network is consulted.  3.2  Understands effect of withdrawal effects and cravings on ability to quit  A2, BM5, BS1, RC6  3.1, 4.2, 5.1  Educational videos and text, feed posts  The user will get to view educational videos and text on the role of cravings and withdrawal, and how social support may be able to help deal with them. The social network is engaged.  Skills    Demonstrates ability to    3.3  - discuss extent of social support with social actor  A2, BS2, BS3  3.1, 4.1, 6.1, 8.1, 15.2  Educational videos, missions, feed posts, social network  The user will receive tips and tricks on how to best utilize the social network. The smoker needs to form a strategy (e.g., by forming implementation intentions) to their social support, and is asked to mentally rehearse how to do it.  3.4  - recognize need for social support  A2, BS1, BS2, BS3, RI3  1.2, 1.3, 1.4, 3.1, 8.1  Educational videos, missions, feed posts, social network  The user will be asked to review scenarios that may have warranted social support in the past and current smoking cessation attempt. The app will warn when potential triggers occur.  3.5.2  Demonstrates ability to discuss social actors support role and performance  A2, BS2, BS3, BS5  3.1, 4.1, 6.1, 8.1  Educational videos, missions, feed posts  Scenarios in which the social support network was inadequate are presented and potential solutions are given.  Beliefs about capabilities  3.1  Expresses positive attitude to using social support in attempt  A2, BM2  3.1, 15.1–15.4  Motivational videos and text, missions, feed posts, social network  Positive information on the use of social support is presented, including real- life examples of other users. Social actors are approached by the app to take initiative.      Demonstrates confidence      3.3  - to talk about quit smoking attempt with social actor  A2, BM2  3.1, 15.1–15.4  Motivational videos and text, missions, feed posts, social network  Positive information on the use of social support is presented, including real- life examples of other users. Social actors are approached by the app to take initiative.    3.5.2  - in discussing social actors support role and performance  A2, BM2  3.1 ,15.1–15.4  Motivational videos and text, missions, feed posts, social network  Positive information on the use of social support is presented, including real- life examples of other users. Social actors are approached by the app to take initiative.  Behavioral regulation  3.3  Identifies social actors of interest  A2, BS3  1.4, 3.1  Suggestions for friends from other social networks, social network, missions  The user will be asked to select friends to join them on Kick.it and outside of Kick.it (for those not tech savvy). The app will give suggestions based on contacts from other social networks.  3.3  Determines (extent of) social support role with social actor  A2, BM6, BS3, RC9  1.4, 1.8, 1.9, 3.1  Missions, feed posts  The user is asked to specify the extent of support each actor will give, for instance the support of the spouse is most probably more intense than the role of a colleague at work. The rules will be set in a contract to force commitment.  3.4  Contacts social support network according to social support rules  A2, BS3, RC9  3.1, 7.1, 8.3  Prompts, feed posts, Kick Stack, social network, missions  The user will be reminded to participate in social network on regular intervals. Smoker is prompted via Kick Stack, and social actor is contacted regularly to engage with user.  3.5  Recalls social support rules and roles  A2, BS1  1.5, 2.3, 3.1  Missions, feed posts  The user will be reminded to actively recall social support rules in their missions.  3.5.1  Recognize unsupportive social actors  A2, BS1, BS5, RC8  1.2, 1.5, 1.6, 1.7, 3.1  Missions, feed posts  Smoker will be prompted to review the social support rules and recognize which social actor is performing well and which one is not.  3.5.2  Changes social support network if deemed necessary  A2, BS1–BS4  1.2, 1.5, 1.7, 3.1  Missions, reminders, feed posts  The user is prompted to change the support actors if they do not deliver up to expectations.  Outcome 4: Smoker resumes quit attempt as soon as possible after slip-up or relapse  TDF  Change objectives  Smoking BCT  BCT  Practical applications  Content of practical application  Knowledge    Demonstrates understanding of      4.1  - common causes of slip-ups and relapse  BM1, BS1  4.2, 5.1  Educational videos and text, feed posts, social network  The user will be able to view educational videos and texts on common reasons that lead to relapse and slip-ups, what to look for and what to avoid. The social network is engaged.    4.2  - difference between slip and relapse  BM1  1.2  Feed posts, social network  The user will view information on the difference between slip-ups and relapsing and is asked to share their own thoughts in the social network.    4.3  - advantages of resuming quit attempt as soon as possible  BM1  5.1  Educational videos and text, feed posts  The user will be presented with facts of the health consequences of resuming smoking cessation and the difficulty that can be expected if they allow their nicotine dependence to return. Remind of pros of smoking cessation.    4.5.2  - strategies to counteract cause of slip-up  BM1, BS1, BS2  4.1  Educational videos and text, feed posts, missions  The user is reminded of high-risk situations and is presented with potential solutions to dealing with these situations. Own views are elicited. They are then asked to formulate their own plan to dealing with potential problematic situations.    4.5.1  Recalls information on effective ways to improve success rate of smoking cessation  A1, A2, BM1, BS3  4.1, 11.1, 11.2, 11.3, 12.1–12.5  Educational videos and text, feed posts, Kick Stack  The user is presented with a recap of the information on effect ways to quit smoking, the use of social support, pharmacotherapy, and the importance of a quit strategy.  Skills  4.1  Demonstrates ability to determine true cause of slip-up  BS1, BS2  1.2, 4.4  Feed posts, push notifications  The user is prompted to analyze the reasons for the slip-up to further understanding of abilities to improve future cessation attempts. Examples are provided to stimulate explanation.  4.5.2  Develops behavioral capacity to counteract cause of current slip-up  BS1, BS2  1.4, 4.1  Prompt after logging smoke, feed post, social network  The smoker is prompted to analyze behaviour and asked to develop strategies to counteract the slip-up in future cases. The social network is utilized.  Beliefs about capabil ities    Expresses positive attitude to    4.3  - reviewing slip-up  BM2  15.1–15.4  Motivational text and video, feed, social network  The user is presented with motivational text to ensure that they review the slip-up. Furthermore, the smoker is asked to interpret the slip-up each time they log a smoke.  4.4  - resuming smoking cessation  BM2  15.1–15.4  Motivational text and video, feed, social network  The user is prompted to restart smoking cessation by motivational texts. The social network is prompted to encourage the user.  4.5  - (revised) smoking cessation strategy  BM2  15.1–15.4  Motivational text and video, feed, social network  The user is presented with positive information regarding their new quit strategy.  4.4  Demonstrates confidence in ability to resume smoking cessation attempt  BM2  15.1–15.4  Motivational text and video, feed, social network  The user is presented with positive motivation based on current quit attempt and framing the message. The social network is prompted to encourage the user.  Behavioral regulation  4.2  Defines personal definition of slip-up versus relapse  BS4  1.4  Missions, reminders, feed posts, social network  The smoker needs to state their own definition of a slip-up and compare this with accepted definitions.    4.3  Assesses current slip-up/ relapse  BS1, BS2  1.2, 2.3  Log smoke button, feed posts  The smoker is able to log cigarettes smoked while still remaining on the quit attempt.    4.4  Plans to recommence quit smoking after slipping up  BS3  1.1, 1.4  Reminders, missions, social network  The smoker is asked to for implementation intentions to ensure recommencement of smoking after slip or relapse. Social network is used to help enable plan.    4.4  Reaffirms nonsmoker identity  BM8  13.5, 15.4  Reminders, feed posts, missions  The smoker is prompted throughout the quit attempts to keep believing and re-affirming in nonsmoking identity.    4.5  Recalls chosen quit strategy  BS1  1.5  Missions, feed posts  The user will be reminded to actively recall the quit strategy.    4.5.1  Reviews quit strategy at regular intervals  BS1, BS5, BS6, RC8  1.2, 1.5, 1.7, 2.3, 2.4  Missions, feed posts  The user will be prompted to review the quit strategy and recognize which elements are and which are not working for them.    4.5.1  Recognizes ineffective elements  BS1, BS5, RC8  1.2, 1.5, 1.6, 1.7  Missions, feed posts  The user will be prompted to review the quit strategy and recognize which elements are and which are not working for them.    4.5.2  Modifies quit strategy if strategy does not work according to expectations  BS1–BS4  1.2, 1.5, 1.7  Missions, feed posts  The user is prompted to change ineffective elements of the quit strategy for the next quit attempt.  Outcome 5: Social environment provides support during the smokers’ cessation attempt  TDF  PO  Change objectives  Smoking BCT  BCT  Practical applications  Content of practical application  Knowledge    Social actor develops understanding of    5.1  - physical and psychological consequences of smoking cessation  BM1, BM5, RC6  3.1, 4.2, 5.1  Educational videos and text, discussion in social network  The social actor will receive information on physical and mental consequences of smoking cessation, if and when they occur and what smokers need to do when they happen.  5.2  - the role of the social environment in smoking (cessation)  A2, BM5, BS1, BS2, BS11  3.1, 4.2, 5.3  Educational videos and text, discussion in social network  The social actor will learn about the positive effects of social support and the potential negative consequences of peer pressure, as well as how the social support has helped other users on Kick.it.  5.2  - evidence-based smoking cessation support methods  A1, BM5, BS2  3.1, 4.1, 5.1, 6.1, 11.1  Educational videos and text, discussion in social network  The social actor will receive information on all different kinds of pharmaceutical and behavioral methods and will learn about positive effects as well as potential side-effects.  5.2  - the importance of and suggestions for a planned quit strategy  BM5,BS1, BS2, BS7, BS8, BS10, BS11  3.1, 4.2, 11.2, 11.3, 12.1– 12.6  Educational videos and text, discussion in social network  The social actor will learn about effective strategies to increase self-control and what smokers can do to increase the chances of success (e.g., limit ego depletion, change routine, and limit cue exposure).  5.3  - ways to provide social support  A2  3.1, 4.1, 6.3  Educational videos and text, discussion in social network  The social actor is given examples of how to provide social support and is prompted to visit the feed and ask other supporters about tips and tricks.  5.2  Social actor distinguishes lay smoking and smoking cessation knowledge from factual knowledge  BM1, RC8, R13  3.1, 4.2, 5.1  Educational videos and text  The social actor will get information on common myths and is asked to compare their own experiences with facts (e.g., cigarettes and stress).  Skills    Social actor demonstrates    5.4  - ability discuss extent of social support with smoker  BS2, BS3, A2  3.1, 4.1, 6.1, 8.1  Educational videos and text, feed posts, social network  The social actor is asked to practice talking to smoker about their quit attempt. Educational videos and text with models are provided.  5.5  - interpersonal skills to provide social support  BS2, BS3, A2  3.1, 4.1, 6.1, 8.1  Educational videos and text, feed posts, social network  The social actor is asked to reflect on previous attempts of social support, in smoking and other areas, and translate that into current attempt. This is supported by modelling videos.  5.5.2  - ability to discuss issues in smoking cessation attempt  BS2, BS3, A2  3.1, 4.1, 6.1, 8.1  Educational videos and text, feed posts, social network  The social actor is asked to reflect on previous attempts of social support, in smoking and other areas, and translate that into current attempt. This is supported by modelling videos.  5.6  - ability to reflect on own performance as social support  A2  3.1, 4.1, 6.1, 8.1  Educational videos and text, feed posts, social network  The actor is asked to reflect on previous attempts of social support and translate that into current attempt. This is supported by educational videos.      Social actor expresses positive attitudes    Beliefs about capabilities  5.1  - to provide social support in quit attempt  A2, BM2  3.1, 13.1, 13.4, 15.1– 15.4  Motivational texts and videos, social network  The supporter is affirmed on their qualities as a supporter and is stimulated to see themselves as a role model to influence others on the platform.  5.2  - toward learning about support methods  A2, BM2  3.1, 15.1– 15.4  Motivational texts and videos, social network  The supporter is prompted with motivational text and is asked to make comparisons with other successful attempts at learning similar behaviors.  5.3  - toward learning about ways to provide support  A2, BM2  3.1, 15.1– 15.4  Motivational texts and videos, social network  The supporter is prompted with motivational text and is asked to make comparisons with other successful attempts at social support using analogies.  5.5  Social actor demonstrates confidence in providing social support during cessation attempt  A2, BM2  3.1, 15.1– 15.4  Motivational texts and videos, social network  The supporter is prompted with motivational text and is asked to make comparisons with other successful attempts at social support using analogies.  Behavioral regulation  5.5  Social actor plans social support role for smoking cessation attempt  A2, BS3  1.1, 1.4, 3.1  Videos and text, prompts  The social actor is prompted to plan their support attempt and ensure they have enough free time to check up on smoker.    5.5.1  Social actor monitors smoking cessation progress of the smoker  A2, BS5  2.1, 3.1  Videos and text, prompts  The social actor is prompted to monitor their support attempt and ensure they have enough free time to check up on smoker.    5.6  Social actor recalls social support agreement  A2, BS1,BS5  1.5, 3.1  Videos and text, prompts  The social actor is prompted to review their agreement and performance.    5.6.1  Social actor reviews social support roles  A2, BS1, BS5, RC8  1.2, 1.5, 1.7, 2.3, 2.4, 3.1  Videos and text, prompts  The social actor is prompted to review their agreement and performance.    5.6.1  Social actor recognizes ineffective elements of their support strategy  A2, BS1, BS5, RC8  1.2, 1.5, 1.6, 1.7, 3.1  Missions, feed posts  The social actor evaluates their own support role and recognized ineffective elements.    5.6.2  Social actor modifies support strategy if inappropriate  A2, BS1–BS4  1.2, 1.5, 1.6, 1.7, 3.1  Videos and text, prompts  The social actor is prompted to change their agreement and performance based on assessment.  Behavioral outcome 1: Smoker develops a personal quit strategy after downloading Kick.it  TDF  PO  Change objectives  Smoking BCT  BCT  Practical applications  Content of practical application  Knowledge    Demonstrates understanding of    1.1  - withdrawal effects associated with smoking cessation  BM1, BM5, RC6  4.2, 5.1  Educational videos and text, discussion in social network  The user will be presented with information on withdrawal effects, what they are, what to expect, and how long they last. Other users share their own experiences on the social platform.  1.1  - the role of cravings in smoking (cessation)  BM1, BM5  4.2, 5.1  Educational videos and text, discussion in social network  The user will learn what cravings are, what to expect in the short and the long term, and how long they last. Other users share their own experiences on the social platform.  1.1  - the role of the social environment in smoking (cessation)  A2, BS11, BM5  3.1, 4.2, 5.3  Educational videos and text, discussion in social network  The user will learn about the positive effects of social support and the potential negative consequences of peer pressure, as well as how it helped other users.  1.1  - physical and psychological consequences of smoking cessation  BM1, BM5  5.1, 9.2  Educational videos and text, discussion in social network  The user will receive information on physical and mental consequences of smoking cessation, if and when they occur and what to do when they happen. They will be asked to determine pros and cons of smoking cessation. Other users share their own experiences on the social platform.  1.2  - evidence-based smoking cessation support methods  A1, A5, BM5  4.1, 5.1, 6.1, 11.1  Educational videos and text, discussion in social network  The user will receive information on all different kinds of pharmaceutical and behavioural methods and will learn about positive effects as well as potential side-effects to monitor and what to do when they happen. Other users share their own experiences on the social platform.  1.3  - effective self-control strategies to aid in smoking cessation  BM5,BS1, BS2, BS7, BS8, BS10, BS11  4.2, 11.2, 11.3, 12.1–12.6  Educational videos and text, discussion in social network  The user will learn about effective strategies to increase self-control and what to do to increase the chances of success (e.g., limit ego depletion, change routine, limit cue exposure, self-affirmation). Other users share their own experiences on the social platform.  1.3  - the role of 5D’s in quit attempt  A1, A2, BM1, BS2  3.1, 4.2, 6.1, 11.1, 12.4  Educational videos and text, discussion in social network  The user will get education on 5D’s (Drink water, Deep breathe, Do something Else, Delay, and Discuss with social support) and why they can help deal with cravings. Other users share their own experiences on the social platform.    Distinguish between    1.1  - facts on smoking (cessation) from lay (mis) perceptions  BM1, RC8, R13  4.2, 5.1  Educational videos and text  The user will get information on common myths and is asked to compare their own experiences with facts (e.g., cigarettes and stress).  1.2  - lay (mis)perceptions about evidence-based support methods from facts  A1, BM1, RC8, R13  4.1, 5.1, 11.1  Educational videos and text  The user is asked to view a video or read a text about various factors associated with smoking cessation (e.g., pharmacotherapy use) and is then asked to compare their own experience with the information provided in the video/text.      Demonstrates ability to    Skills  1.5  - use pharmacotherapy according to prescription (if selected)  A1, BS2, BS3  1.4, 4.1, 6.1, 7.1, 8.3, 11.1  Educational video and text, reminders, logging of medication use, reminders  The smoker will view information that explains how to properly use pharmacotherapy. They can log their medication intake and craving pattern, and prompts and cues will be given to remind them to use the medication consistently.  1.5  - use of the 5D’s when craving  BS2, BS3  1.4, 4.1, 6.1, 7.1, 8.2, 8.3  Kick Stack, Educational video and text, reminders  After logging each smoke and crave, the smoker will be presented with random suggestions of 5D’s. Social support is facilitated via the social network.  1.5  - contact social actors according to social support rules  A2, BS2, BS3  1.4, 3.1, 7.1  Social network, reminders, Educational video and text  The user has access to social support network on the app. They furthermore receive reminders and prompts to utilize social network when needed (e.g., when cravings or withdrawal symptoms are strong). Videos and text are given that provide examples on how to broach the topic with social actors.  1.5  - implement self-control strategies before and during quit attempt  A5, BS2, BS3, BS7–BS11  1.2, 1.4, 3.1, 6.1, 7.1, 11.2, 11.3, 12.1–12.6  Educational videos and text, reminders, missions  The user can complete daily missions that aim to ensure they stick to the self-control strategy. Reminders are given repeatedly.  Beliefs about capabilities    Demonstrates confidence    1.1  - toward successfully quitting smoking  BM2, BM3, BM8, RC10, RI2  2.2, 13.4, 13.5, 15.1–15.4  Missions, feed posts, health and money feedback, social support, normative feedback  The user is reminded of ex-smoking identity, is motivated throughout and reminded of personal strength (e.g., via self-affirmation). Normative information on other smokers is provided as reference point. Health feedback and feedback of supporters are used to boost motivation further.  1.4  - that chosen smoking cessation strategy will be optimal solution for quit attempt  BM2, RD2, RI2  2.2, 15.1–15.4  Missions, feed posts, social network  The user is asked to actively think about the chosen quit strategy before the quit attempt to ensure it is the most optimal solution at the time. Choice is emphasized. The social network is prompted to provide supportive messages.  1.5  - in successfully executing chosen quit smoking strategy  BM2, RD2, RI2  2.2, 13.5, 15.1–15.4  Missions, feed posts, social network  The user is asked to commit to a quit strategy and to visualize the strategy working in the quit attempt. The social network is prompted to provide supportive messages.    Expresses positive attitudes    1.2  - toward using evidence-based support methods  BM2, BM5, RD2  6.3, 15.1–15.4  Prompts, feed posts, health and money feedback, social support, normative feedback, feed posts  The user is reminded of success rate of evidence-based support and coping models are used to bolster efficacy. Information on side-effects is provided. Normative information on other smokers is provided as reference point. Smoker is asked to visualize performing the behavior.  1.6.2  - toward changing quit smoking strategy if strategy is not working according to expectations  BM2, RD2  15.1–15.4  Missions, feed posts  The user will be prompted to (imagine) changing their quit smoking strategy if it is not appropriate or leads to undesirable results.  Behavioral regulation  1.4  Identifies effective strategies from past quit attempts  RI1, RI3  15.3  Missions, feed posts  The user is asked to evaluate previous quit attempts to see what worked and what did not.  1.4  Summarizes selected quit strategy  BS3, BS4, RC9  1.1, 1.3, 1.9  Missions, feed posts  The user is asked to repeat the quit strategy and its components (e.g., implementation intentions for dealing with high-risk situations) and determine the eventual treatment goals.  1.4  Commits to executing quit strategy  BM6  1.8, 1.9  Missions, feed posts, export to social media  The user is prompted to share the quit date and its components on Kick.it and social media.  1.5  Monitors withdrawal symptoms after quitting cigarettes  A4, BS6, RI4  2.4  Missions, feed posts  The user is reminded to monitor withdrawal symptoms and to contact a health professional if the symptoms get too much  1.5  Monitors craving pattern to understand quit smoking attempt  BS6  2.1, 2.4  Craving feedback, feed posts  The user can monitor the craving pattern via the app, based on the logged data, and is asked to actively monitor for potential trigger to avoid.  1.5  Affirms nonsmoking identity  BM8  13.5  Missions, feed posts, social network  The user is asked to construct a nonsmoking identity at multiple occasions (e.g., on social network and via missions)  1.6  Recalls chosen quit strategy  BS1  1.5  Missions, feed posts  The user is prompted to recall the quit strategy via the missions to identify what works and what does not.  1.6.1  Reviews quit strategy at regular intervals  BS1, BS5, BS6, RC8  1.2, 1.5, 1.7, 2.3, 2.4  Missions, feed posts  The user is prompted to actively review elements of the quit attempt to see what works and what does not.  1.6.1  Recognizes ineffective elements  BS1, BS5, RC8  1.2, 1.5, 1.6, 1.7  Missions, feed posts  The user is prompted to actively review elements of the quit attempt.  1.6.2  Modifies quit strategy if strategy does not work according to expectations  BS1–BS4  1.2, 1.5, 1.7  Missions, feed posts  The user is prompted to change ineffective elements of the quit strategy if necessary.  Outcome 2: Smoker adheres to pharmacotherapy treatment plan  TDF  PO  Change objectives  Smoking BCT  BCT  Practical applications  Content of practical application  Knowledge    Increases understanding of      2.1  - side-effects of smoking cessation pharmacotherapy  BM5, A1, A4  5.1, 6.2, 11.1  Educational videos and text, feed posts, social network  The user is presented with information explaining potential side-effects and what to look for. Their personal experiences are explored and the social network is engaged.    2.1  - beneficial effects of smoking cessation pharmacotherapy  BM5, A1, A4  5.1, 6.2, 11.1  Educational videos and text, feed posts, social network  The user is presented with information explaining beneficial effects of pharmacotherapy. Their personal experiences are explored and the social network is engaged.    2.2  - potential pharmacotherapy options  BM5, A1, A4  6.2, 11.1  Educational videos and text, medication list  The user is presented with educational content on pharmacotherapy. The social network is prompted to share experiences.    2.4  - exact treatment protocol of pharmacotherapy  A1  4.1, 11.1  Educational videos and text  The user will be able to read education information or watch videos explaining how to use each individual product and why they have to stick to the treatment regimen.  Skills  2.3  Acquires pharmacotherapy  A1, A3  4.1, 6.1, 11.1  Instructional videos and text, potential order button/link- out via Kick.it  The user receives information on where to get pharmacotherapy and what the potential costs are.  2.5  Demonstrates ability to use pharmacotherapy at correct dose and at correct interval  A1  4.1, 6.1, 7.1 , 11.1  Instructional videos and text, reminders, Kick Stack, CareCard, feed posts  The user will be able to read education information or watch videos explaining how to use each individual product. Furthermore, the app will give reminders to education on use of product and prompt review of its effects.  Beliefs about capabilities  2.1  Alters lay perceptions on pharmacotherapy if needed  A1, RC8, RI3  11.1, 15.3  Motivational text and video, feed, social network  The user is asked to compare factual information with lay experiences or information received from other lay sources, myths are debunked.    Demonstrates confidence    2.5  - in using pharmaceutical support according to treatment protocol  A1, BM2  11.1, 15.1–15.4  Motivational text and video, feed, social network, reminders  The user is presented with motivational text and videos. The social network is utilized to further bolster support. Reminders help them stay on track.  2.6.1  - to approach health professional in case of problems with pharmacotherapy solution  A1, BM2  11.1, 15.1–15.4  Motivational text and video, feed posts  The user is provided motivational content that aims to bolster confidence to broach medication with their health professional. Health professionals will feature in videos.  2.6.1  - to approach health professional in case of problems with pharmacotherapy solution  A1, BM2  11.1, 15.1–15.4  Motivational text and video, feed posts  The user is provided motivational content that aims to bolster confidence to broach medication with their health professional. Health professionals will feature in videos.    Expresses positive attitudes    2.1  - toward using pharmaceutical support  A1, BM2  11.1, 15.1–15.4  Motivational text and video, feed, social network  The user is provided motivational facts and videos on how pharmacotherapy will help them and has helped millions of other smokers. Other smokers are asked to share their positive experiences.  2.6.2  - toward changing pharmacotherapy if desired effect is not reached  A1, BM2  11.1, 15.1–15.4  Motivational text and video, feed, social network  The user can view information that informs changing treatment regimens is necessary for optimal results.  Behavioral regulation  2.4  Ensures to have sufficient quantity of pharmacotherapy at start of quit attempt  A1, BS3  1.4, 11.1  Missions, reminders, feed posts, social network  The user is on multiple occasions reminder to ensure to have enough product in possession. Social network is asked to verify.    2.5  Recognizes mental/ physical symptoms that trigger need for pharmacotherapy  A1, BS1  1.2, 11.1  Missions, reminders, feed posts, log a crave  The user is reminded to monitor physical and emotional symptoms that may trigger need for use of pharmacotherapy. Suggestions will be made based on cravings logged.    2.6  Recalls treatment protocol of pharmacotherapy of choice  A1, BS1  1.5, 2.3, 11.1  Missions, reminders, feed posts, CareCard  The user is prompted to review the use of pharmacotherapy in missions and in regular feed posts. CareCard may prompt treatment as well.    2.6.1  Compare expected effect of pharmacotherapy with own experience  A1, A4, BS1, BS5, BS6, RC8  1.6, 1.7, 2.4, 11.1  Missions, reminders, feed posts, CareCard  The user is reminder of information about the positive and negative effects of the pharmacotherapy they are using. They are then asked to compare their own experiences.    2.6.1  Monitor side-effects caused by pharmacotherapy  A1, A4, BS1, BS5, BS6, RC8  1.6, 1.7, 2.4, 11.1  Missions, reminders, feed posts  The user is asked to monitor side-effects of pharmacotherapy regularly.    2.7.2  Modifies use of pharmacotherapy if inappropriate  BS1–BS4, A1  1.2, 1.5, 1.7, 11.1  Missions, reminders, feed posts  The user is prompted to revisit use of pharmacotherapy and talk to a health professional if the pharmacotherapy does not lead to desired result.  Outcome 3: Smoker utilizes social support network  TDF  PO  Change objectives  Smoking BCT  BCT  Practical applications  Content of practical application  Knowledge  3.1  Describes beneficial aspects of social support in quit attempt  A2, BM5  3.1  Educational videos and text , feed posts, social network  The user will be exposed to educational videos and text on the role of social support in the ability to quit, and is asked to engage the social network to ask about positive experiences of other users.  3.2  Defines high- risk relapse situations  A2, BM5, BS1, BS2, BS10, BS11  3.1, 4.2  Educational videos and text, feed posts  The user will be asked to define personal high- risk situations in which relapse is expected and when social support may be beneficial. Videos and text with examples are provided and the social network is consulted.  3.2  Understands effect of withdrawal effects and cravings on ability to quit  A2, BM5, BS1, RC6  3.1, 4.2, 5.1  Educational videos and text, feed posts  The user will get to view educational videos and text on the role of cravings and withdrawal, and how social support may be able to help deal with them. The social network is engaged.  Skills    Demonstrates ability to    3.3  - discuss extent of social support with social actor  A2, BS2, BS3  3.1, 4.1, 6.1, 8.1, 15.2  Educational videos, missions, feed posts, social network  The user will receive tips and tricks on how to best utilize the social network. The smoker needs to form a strategy (e.g., by forming implementation intentions) to their social support, and is asked to mentally rehearse how to do it.  3.4  - recognize need for social support  A2, BS1, BS2, BS3, RI3  1.2, 1.3, 1.4, 3.1, 8.1  Educational videos, missions, feed posts, social network  The user will be asked to review scenarios that may have warranted social support in the past and current smoking cessation attempt. The app will warn when potential triggers occur.  3.5.2  Demonstrates ability to discuss social actors support role and performance  A2, BS2, BS3, BS5  3.1, 4.1, 6.1, 8.1  Educational videos, missions, feed posts  Scenarios in which the social support network was inadequate are presented and potential solutions are given.  Beliefs about capabilities  3.1  Expresses positive attitude to using social support in attempt  A2, BM2  3.1, 15.1–15.4  Motivational videos and text, missions, feed posts, social network  Positive information on the use of social support is presented, including real- life examples of other users. Social actors are approached by the app to take initiative.      Demonstrates confidence      3.3  - to talk about quit smoking attempt with social actor  A2, BM2  3.1, 15.1–15.4  Motivational videos and text, missions, feed posts, social network  Positive information on the use of social support is presented, including real- life examples of other users. Social actors are approached by the app to take initiative.    3.5.2  - in discussing social actors support role and performance  A2, BM2  3.1 ,15.1–15.4  Motivational videos and text, missions, feed posts, social network  Positive information on the use of social support is presented, including real- life examples of other users. Social actors are approached by the app to take initiative.  Behavioral regulation  3.3  Identifies social actors of interest  A2, BS3  1.4, 3.1  Suggestions for friends from other social networks, social network, missions  The user will be asked to select friends to join them on Kick.it and outside of Kick.it (for those not tech savvy). The app will give suggestions based on contacts from other social networks.  3.3  Determines (extent of) social support role with social actor  A2, BM6, BS3, RC9  1.4, 1.8, 1.9, 3.1  Missions, feed posts  The user is asked to specify the extent of support each actor will give, for instance the support of the spouse is most probably more intense than the role of a colleague at work. The rules will be set in a contract to force commitment.  3.4  Contacts social support network according to social support rules  A2, BS3, RC9  3.1, 7.1, 8.3  Prompts, feed posts, Kick Stack, social network, missions  The user will be reminded to participate in social network on regular intervals. Smoker is prompted via Kick Stack, and social actor is contacted regularly to engage with user.  3.5  Recalls social support rules and roles  A2, BS1  1.5, 2.3, 3.1  Missions, feed posts  The user will be reminded to actively recall social support rules in their missions.  3.5.1  Recognize unsupportive social actors  A2, BS1, BS5, RC8  1.2, 1.5, 1.6, 1.7, 3.1  Missions, feed posts  Smoker will be prompted to review the social support rules and recognize which social actor is performing well and which one is not.  3.5.2  Changes social support network if deemed necessary  A2, BS1–BS4  1.2, 1.5, 1.7, 3.1  Missions, reminders, feed posts  The user is prompted to change the support actors if they do not deliver up to expectations.  Outcome 4: Smoker resumes quit attempt as soon as possible after slip-up or relapse  TDF  Change objectives  Smoking BCT  BCT  Practical applications  Content of practical application  Knowledge    Demonstrates understanding of      4.1  - common causes of slip-ups and relapse  BM1, BS1  4.2, 5.1  Educational videos and text, feed posts, social network  The user will be able to view educational videos and texts on common reasons that lead to relapse and slip-ups, what to look for and what to avoid. The social network is engaged.    4.2  - difference between slip and relapse  BM1  1.2  Feed posts, social network  The user will view information on the difference between slip-ups and relapsing and is asked to share their own thoughts in the social network.    4.3  - advantages of resuming quit attempt as soon as possible  BM1  5.1  Educational videos and text, feed posts  The user will be presented with facts of the health consequences of resuming smoking cessation and the difficulty that can be expected if they allow their nicotine dependence to return. Remind of pros of smoking cessation.    4.5.2  - strategies to counteract cause of slip-up  BM1, BS1, BS2  4.1  Educational videos and text, feed posts, missions  The user is reminded of high-risk situations and is presented with potential solutions to dealing with these situations. Own views are elicited. They are then asked to formulate their own plan to dealing with potential problematic situations.    4.5.1  Recalls information on effective ways to improve success rate of smoking cessation  A1, A2, BM1, BS3  4.1, 11.1, 11.2, 11.3, 12.1–12.5  Educational videos and text, feed posts, Kick Stack  The user is presented with a recap of the information on effect ways to quit smoking, the use of social support, pharmacotherapy, and the importance of a quit strategy.  Skills  4.1  Demonstrates ability to determine true cause of slip-up  BS1, BS2  1.2, 4.4  Feed posts, push notifications  The user is prompted to analyze the reasons for the slip-up to further understanding of abilities to improve future cessation attempts. Examples are provided to stimulate explanation.  4.5.2  Develops behavioral capacity to counteract cause of current slip-up  BS1, BS2  1.4, 4.1  Prompt after logging smoke, feed post, social network  The smoker is prompted to analyze behaviour and asked to develop strategies to counteract the slip-up in future cases. The social network is utilized.  Beliefs about capabil ities    Expresses positive attitude to    4.3  - reviewing slip-up  BM2  15.1–15.4  Motivational text and video, feed, social network  The user is presented with motivational text to ensure that they review the slip-up. Furthermore, the smoker is asked to interpret the slip-up each time they log a smoke.  4.4  - resuming smoking cessation  BM2  15.1–15.4  Motivational text and video, feed, social network  The user is prompted to restart smoking cessation by motivational texts. The social network is prompted to encourage the user.  4.5  - (revised) smoking cessation strategy  BM2  15.1–15.4  Motivational text and video, feed, social network  The user is presented with positive information regarding their new quit strategy.  4.4  Demonstrates confidence in ability to resume smoking cessation attempt  BM2  15.1–15.4  Motivational text and video, feed, social network  The user is presented with positive motivation based on current quit attempt and framing the message. The social network is prompted to encourage the user.  Behavioral regulation  4.2  Defines personal definition of slip-up versus relapse  BS4  1.4  Missions, reminders, feed posts, social network  The smoker needs to state their own definition of a slip-up and compare this with accepted definitions.    4.3  Assesses current slip-up/ relapse  BS1, BS2  1.2, 2.3  Log smoke button, feed posts  The smoker is able to log cigarettes smoked while still remaining on the quit attempt.    4.4  Plans to recommence quit smoking after slipping up  BS3  1.1, 1.4  Reminders, missions, social network  The smoker is asked to for implementation intentions to ensure recommencement of smoking after slip or relapse. Social network is used to help enable plan.    4.4  Reaffirms nonsmoker identity  BM8  13.5, 15.4  Reminders, feed posts, missions  The smoker is prompted throughout the quit attempts to keep believing and re-affirming in nonsmoking identity.    4.5  Recalls chosen quit strategy  BS1  1.5  Missions, feed posts  The user will be reminded to actively recall the quit strategy.    4.5.1  Reviews quit strategy at regular intervals  BS1, BS5, BS6, RC8  1.2, 1.5, 1.7, 2.3, 2.4  Missions, feed posts  The user will be prompted to review the quit strategy and recognize which elements are and which are not working for them.    4.5.1  Recognizes ineffective elements  BS1, BS5, RC8  1.2, 1.5, 1.6, 1.7  Missions, feed posts  The user will be prompted to review the quit strategy and recognize which elements are and which are not working for them.    4.5.2  Modifies quit strategy if strategy does not work according to expectations  BS1–BS4  1.2, 1.5, 1.7  Missions, feed posts  The user is prompted to change ineffective elements of the quit strategy for the next quit attempt.  Outcome 5: Social environment provides support during the smokers’ cessation attempt  TDF  PO  Change objectives  Smoking BCT  BCT  Practical applications  Content of practical application  Knowledge    Social actor develops understanding of    5.1  - physical and psychological consequences of smoking cessation  BM1, BM5, RC6  3.1, 4.2, 5.1  Educational videos and text, discussion in social network  The social actor will receive information on physical and mental consequences of smoking cessation, if and when they occur and what smokers need to do when they happen.  5.2  - the role of the social environment in smoking (cessation)  A2, BM5, BS1, BS2, BS11  3.1, 4.2, 5.3  Educational videos and text, discussion in social network  The social actor will learn about the positive effects of social support and the potential negative consequences of peer pressure, as well as how the social support has helped other users on Kick.it.  5.2  - evidence-based smoking cessation support methods  A1, BM5, BS2  3.1, 4.1, 5.1, 6.1, 11.1  Educational videos and text, discussion in social network  The social actor will receive information on all different kinds of pharmaceutical and behavioral methods and will learn about positive effects as well as potential side-effects.  5.2  - the importance of and suggestions for a planned quit strategy  BM5,BS1, BS2, BS7, BS8, BS10, BS11  3.1, 4.2, 11.2, 11.3, 12.1– 12.6  Educational videos and text, discussion in social network  The social actor will learn about effective strategies to increase self-control and what smokers can do to increase the chances of success (e.g., limit ego depletion, change routine, and limit cue exposure).  5.3  - ways to provide social support  A2  3.1, 4.1, 6.3  Educational videos and text, discussion in social network  The social actor is given examples of how to provide social support and is prompted to visit the feed and ask other supporters about tips and tricks.  5.2  Social actor distinguishes lay smoking and smoking cessation knowledge from factual knowledge  BM1, RC8, R13  3.1, 4.2, 5.1  Educational videos and text  The social actor will get information on common myths and is asked to compare their own experiences with facts (e.g., cigarettes and stress).  Skills    Social actor demonstrates    5.4  - ability discuss extent of social support with smoker  BS2, BS3, A2  3.1, 4.1, 6.1, 8.1  Educational videos and text, feed posts, social network  The social actor is asked to practice talking to smoker about their quit attempt. Educational videos and text with models are provided.  5.5  - interpersonal skills to provide social support  BS2, BS3, A2  3.1, 4.1, 6.1, 8.1  Educational videos and text, feed posts, social network  The social actor is asked to reflect on previous attempts of social support, in smoking and other areas, and translate that into current attempt. This is supported by modelling videos.  5.5.2  - ability to discuss issues in smoking cessation attempt  BS2, BS3, A2  3.1, 4.1, 6.1, 8.1  Educational videos and text, feed posts, social network  The social actor is asked to reflect on previous attempts of social support, in smoking and other areas, and translate that into current attempt. This is supported by modelling videos.  5.6  - ability to reflect on own performance as social support  A2  3.1, 4.1, 6.1, 8.1  Educational videos and text, feed posts, social network  The actor is asked to reflect on previous attempts of social support and translate that into current attempt. This is supported by educational videos.      Social actor expresses positive attitudes    Beliefs about capabilities  5.1  - to provide social support in quit attempt  A2, BM2  3.1, 13.1, 13.4, 15.1– 15.4  Motivational texts and videos, social network  The supporter is affirmed on their qualities as a supporter and is stimulated to see themselves as a role model to influence others on the platform.  5.2  - toward learning about support methods  A2, BM2  3.1, 15.1– 15.4  Motivational texts and videos, social network  The supporter is prompted with motivational text and is asked to make comparisons with other successful attempts at learning similar behaviors.  5.3  - toward learning about ways to provide support  A2, BM2  3.1, 15.1– 15.4  Motivational texts and videos, social network  The supporter is prompted with motivational text and is asked to make comparisons with other successful attempts at social support using analogies.  5.5  Social actor demonstrates confidence in providing social support during cessation attempt  A2, BM2  3.1, 15.1– 15.4  Motivational texts and videos, social network  The supporter is prompted with motivational text and is asked to make comparisons with other successful attempts at social support using analogies.  Behavioral regulation  5.5  Social actor plans social support role for smoking cessation attempt  A2, BS3  1.1, 1.4, 3.1  Videos and text, prompts  The social actor is prompted to plan their support attempt and ensure they have enough free time to check up on smoker.    5.5.1  Social actor monitors smoking cessation progress of the smoker  A2, BS5  2.1, 3.1  Videos and text, prompts  The social actor is prompted to monitor their support attempt and ensure they have enough free time to check up on smoker.    5.6  Social actor recalls social support agreement  A2, BS1,BS5  1.5, 3.1  Videos and text, prompts  The social actor is prompted to review their agreement and performance.    5.6.1  Social actor reviews social support roles  A2, BS1, BS5, RC8  1.2, 1.5, 1.7, 2.3, 2.4, 3.1  Videos and text, prompts  The social actor is prompted to review their agreement and performance.    5.6.1  Social actor recognizes ineffective elements of their support strategy  A2, BS1, BS5, RC8  1.2, 1.5, 1.6, 1.7, 3.1  Missions, feed posts  The social actor evaluates their own support role and recognized ineffective elements.    5.6.2  Social actor modifies support strategy if inappropriate  A2, BS1–BS4  1.2, 1.5, 1.6, 1.7, 3.1  Videos and text, prompts  The social actor is prompted to change their agreement and performance based on assessment.  Change objectives matched with the PO and TDF determinant they belong to. Each change objective is coded for evidence-based BCTs for smoking [26] and for general behavioral change [27]. They are then translated into practical applications. The final column describes the specific content of each practical application. PO performance objectives; TDF Theoretical domains Framework. View Large Step 4: Design of Kick.it Steps 1–3 indicated the need for a smartphone app that can provide a tailored solution for a wide range of smokers, all of whom require different individualized solutions to become smoke free as a result of each individuals different characteristics (e.g., age, gender, ethnicity, and motivations). This is no different than the counselling process of a professional counsellor; they adjust their program and the approach they intend to use to the specific individual they have sitting across from them. This became the focus point for design and development of Kick.it, and it utters itself in three main principles. Firstly, Kick.it is behavioral theory and therapy “agnostic”. Rather than designing an app that uses a specific behavioral change approach to achieve smoking cessation, for example one based on cognitive behavioral theory [80], it was decided that Kick.it should become a holistic smoking cessation solution, allowing a wide variety of methods and programs to be available for the smoker to choose from. The core framework of Kick.it is however not simply multitheoretical, in that it offers its users a variety of set approaches or “therapies” they can choose from; rather it provides its users with individual active elements of the approaches or therapies. Each user has access to a variety of active tools (and thus behavioral change methods) to stay smoke free and can determine which element works for that specific individual. This ultimately should lead to the creation of a personal strategy for smoking cessation consisting out of all the tools that work for that individual, while systematically rooting out the tools that do not. To make sure that the user does not face a multitude of (irrelevant) information and suggestions, which may result in a high cognitive load [81], which can lead to choice paralysis [82], Kick.it tailors its provision of information to the user characteristics. This again is no different to the process of professional counseling, and in this case, it means that Kick.it will eventually change the look and feel of the app to suit its users better (e.g., the language and examples used); it will aim to provide the most relevant suggestions for each user and subsequently try to reduce irrelevant suggestions. Furthermore, the app will display certain features in different ways to reduce the occurrence of choice paralysis. For instance, users can choose to select a strategy to deal with cravings based on what they want at that specific moment (e.g., using mindfulness to deal with cravings [83]) or they can use a “shuffle” function, where the app provides random suggestions they can trial to beat the cravings; suggestions that in the long run will be tailored to each user category after studying which user benefits most from what strategy. The third main principle, which is related to the above-mentioned principles, is the fact that Kick.it aims to provide a personalized quit journey. For this project, personalization is meant according to the description provided in the PSD framework, being: “A system that offers personalized content or services has a greater capability for persuasion,” where personalization refers to content tailored to fit the characteristics of individual users. This means that, in our app, our users can search for as well as upload and share personal content, which can aid in the cessation attempt. For instance, rather than using stock images of random people, the user can upload a picture of their family members to boost motivation. Furthermore, the user can indicate preferences for specific content, which down the track will influence the content that the app will show. The app hosts a number of core features that are described below. To ensure these features are used, we designed the app as a persuasive technology, guided by principles of the PSD framework [20]. Table 3 further details how each function relates to the design guidelines of the PSD framework. Table 3 Description of the Persuasive System Design (PSD) Framework with example features of Kick.it and quotes of the qualitative interviews Category  PSD element  Description  Kick.it features  Quotes belonging to domain (main PSD element)  Primary Task Support  Reduction  A system that reduces complex behavior into simple tasks helps users perform the target behavior, and it may increase the benefit/cost ratio of a behavior.  - Logging cigarettes smoked and cravings felt - Missions - Reminders - Kick stack  HP6: “It has to be fairly simple to use. Even if patients have worked out how to use their phone, that does not mean they know how to access other things that are on their phone.” (Reduction) SM3: “You know it has got to be easy, I am wearing glasses. It needs to be easy to look at being an older person.” (Reduction) HP1: "It needs to have a lot of options so you can tailor it for each person.” (Tailoring) HP7: "Smoking cessation advice always depends on the person, so tailoring in the app is important." (Tailoring) SM1: “I would not care; [social comparison] would not have any effect on me… If my friends have not smoked for a week, to me that does not mean anything. I’m just concerned about my health.” (Tailoring) SM6: “The app has to be able to adapt… if the person is 55 years old, it is not treating them like they are 15 years old. Conversely, if they are 25 year old they will not be spoken to like a 60 year old.” (Tailoring) HP1: “Or they could say put a photo of their grandchild and then write ‘want to see [your grandchild] go to school’ or something like that, so that their phone pops this up, so when they want to smoke they reach for their phone and it goes ‘Don’t smoke that cigarette, want to see [your grandchild] go to school’.” [Personalization] SM4: "Going back to the financial aspect. If you were to say you know: you put in how much a packet of cigarettes has been over a certain amount of time. You spend this amount of money and you say that is equivalent to [something] you put in the beginning. Like the things you like to do, like travel, or go to shows, or buy clothes or whatever. That is equivalent to, you could have gone to Bali. That could be an incentive for people." (Personalization) HP7: "I like that I can see my progress on a daily basis, but also from month to month when [I use other apps]. That could also work for Kick.it." (Self-monitoring) HP9: “You know what would be perfect… it would be awesome if the app could tell us when they last smoked. It would be so cool to have an app that validates people, you know to monitor them.” (Self-monitoring) HP2: "What if you had a visual Tamagotchi kind of thing, that if they didn't stay abstinent, it would slowly get sicker." (simulation)  Tunnelling  Using the system to guide users through a process or experience provides opportunities to persuade along the way.  - Log crave and smoke - Kick Stack- Social network  Tailoring  Information provided by the system will be more persuasive if it is tailored to the potential needs, interests, personality, usage context, or other factors relevant to a user group.  - Missions- Individualized treatment plan - Future tailoring based on individual characteristics  Personalization  A system that offers personalized content or services has a greater capability for persuasion.  - Kick Stack - Social network - Future tailoring based on individual characteristics  Self-monitoring  A system that keeps track of one’s own performance or status supports the user in achieving goals  - Health and monetary feedback- Craving Tracker- Missions- Feedback in Kick Stack  Simulation  Systems that provide simulations can persuade by enabling users to observe immediately the link between cause and effect.  - Educational and motivational videos  Rehearsal  A system providing means with which to rehearse a behavior can enable people to change their attitudes or behavior in the real world.  - Missions- Kick Stack  Dialogue support  Praise  By offering praise, a system can make users more open to persuasion.  - Kick Stack- Social network- Health and monetary feedback- Missions  HP3: "“I think feedback is very important, because the patients become very proud when I ask them to lose some weight, they come back saying have a look [at personal weight app], see so many km in the past few days, so I think the feedback from the app to the patients, is the most important thing”(Praise) SM1: "The health aspect and the savings. Having that constant content pushing while you go about your daily activities. Having that come up like bang you know` you saved 290 dollar on ciggies in weeks. That was important. To sort of push it along the way" (praise) HP1: “You should get a sponsor from a nicotine replacement company… the more points they get, they can cash it in with a loyalty card at [a local business] for Nicotine Replacement Therapy”. (rewards) HP10: “harnessing the interest of people, making them come back. They have to come back. With built in incentives. Some people will get excited to see how many emoji’s they got, some people won’t”. (rewards) HP4: "if the app gives a beep to remind you that you haven't checked in for the day, how are you going? [you think] Ah ok I got to do this, it is kind of a reinforcement of 'ah yes I am doing this and this is what I need to work towards" (reminder) HP9: “Using real people, using images they can relate to... local people” (similarity) HP9: " It needs to be visual…[ [My patients] don't really like to read that much, so it should not require a lot of reading. Video's, Images." (liking) SM6: “A bit of comedy, a bit of humour, just to keep people motivated [ to keep using the app]" (liking) SM9: “I’m interested in a visual story, for me a vidual story would be easy [to follow]”. (Liking) HP1: “[I want to see] Feedback on money. Something that shows them the reasons why stopping smoking is good. That might remind them at intervals (self-monitoring) SM7: “Tracking my progress and letting me learn from previous attempts [would be valuable functionality]  Rewards  Systems that reward target behaviors may have great persuasive powers  - Health and monetary feedback - Future gamification of quit process  Reminders  If a system reminds users of their target behavior, the users will more likely achieve their goals.  - Push notifications- Health feedback  Suggestion  Systems offering fitting suggestions will have greater persuasive powers.  - Kick Stack- Social network- Push notifications  Similarity  People are more readily persuaded through systems that remind them of themselves in some meaningful way.  - Different versions tailored to user characteristics (e.g., indigenous, mental health)- Future availability in different languages  Liking  A system that is visually attractive for its users is likely to be more persuasive.  - Visual health feedback - Use of GIF's and videos rather than text- use of emoji’s  Social role  If a system adopts a social role, users will more likely use it for persuasive purposes.  - Future integration of bot or avatar - Social network  System credibility  Trustworthiness  A system that is viewed as trustworthy will have increased powers of persuasion.  - Logos of collaborative partners - Research focus  HP1: “You need to say that we won’t identify [the user], and that your privacy will always be respected.” (Trustworthiness) SM6: “When you are using the app it [needs to] look like it was written by people who knew what they were doing. One of the significant things with anything technology-based, it has to instil confidence from the user.” (Expertise) SM1: “If I was looking for an app for running, I would not go for anything that is low rated or not downloaded. So unless it is something specific I am going for and I am looking for it, you always look at the top tier [for downloads].” (Surface credibility) SM5: “If I found [Kick.it] interesting… I will see how many people downloaded it first, then I will download it. So that’s uh, if you want to attract me or something that’s one of the things.” (Surface credibility) SM8: “I used one of the government quit smoking apps, but it was very surfacy… it just was not good enough.” (Surface credibility) HP6: “If you can involve Quitline that would be an option as well. As you know Quitline is a big organization and if you can involve Quitline then they maybe will be doing some marketing and will help with getting more people… on the same time you can add a button so people can call Quitline if they are in trouble.” (Authority/third-party endorsement)    Expertise  A system that is viewed as incorporating expertise will have increased powers of persuasion.  - Logos of collaborative partners - Laymen explanation of journal articles on Kick.it are pushed through feeds    Surface credibility  People make initial assessments of the system credibility based on a firsthand inspection.  - Ensure high reviews and ratings in app store - Research focus of the app    Real-world feel  A system that highlights people or organization behind its content or services will have more credibility.  - Constant publication of real user experiences in-app and social network    Authority  A system that leverages roles of authority will have enhanced powers of persuasion.  - University and research institute Endorsement and research focus of the app    Third-party endorsements  Third-party endorsements, especially from well-known and respected sources, boost perceptions on system credibility.  - University, health professional, and research institute endorsement      Verifiability  Credibility perceptions will be enhanced if a system makes it easy to verify the accuracy of site content via outside sources.  - Information in app will (where possible) have referencing or link-outs    Social support  Social learning  A person will be more motivated to perform a target behavior if (s)he can use a system to observe others performing the behavior.  - Social network - Progress feedback  SM5 “what might work is for example if there is a push notification [saying] ‘ok two of your friends didn’t smoke today, or two of your friends only smoked this amount today, they have decreased their smoking’. So I can see my friends are slowing down.” (Social learning) HP1 - "what you want is people in Kick.it that are in your immediate vicinity, so if you are in a pub you can go up and make friends with them, Like Tinder." (Social facilitation) HP10 - “I think the forum, the forum is really the one, because you can feed that [with content].” (Social facilitation) SM6: “Who are you talking to? Some stranger. You don’t know who that person is, what’s their experience… When you are crying on somebodies shoulder, you want to have some level of understanding. Not some scripted response. That’s where you need your buddy. In fact, that’s where an avatar based app can come in. Somebody you can talk to… And the app talks back to you. For a single person quitting on their own they need to build a relationship with somebody.” (Social facilitation) HP10 - “It would need to have incentives, like winning things and adding badges and all that stuff that people get competitive about.” (Competition) SM4: Yeah so for "Map my run"… I can see when [friend] and another few mates of mine who are using it, when they have a workout we can comment, hey i like that you just done that and we can have communication through that app as well. (Cooperation) SM3: For me it’s the human community... if you are going to succumb to a ciggie, you can find a buddy. (Social facilitation) SM4: Half the time when you want to have a cigarette, you really have the thoughts: I want to have that cigarette, I want to have that cigarette... [if then] someone else goes like “do not worry about it, don’t do it”, somebody else that stimulates you and takes you on another track. (Social facilitation)  Social comparison  System users will have a greater motivation to perform the target behavior if they can compare their performance with the performance of others.  - Missions - Social network - Progress feedback  Normative influence  A system can leverage normative influence or peer pressure to increase the likelihood that a person will adopt a target behavior  - Missions - Social network - Progress feedback  Social facilitation  System users are more likely to perform target behavior if they discern via the system that others are performing the behavior along with them.  - Social network - Progress feedback  Cooperation  A system can motivate users to adopt a target attitude or behavior by leveraging human beings’ natural drive to co-operate  - Mission that stimulates quitting together with a friend - Social network - Progress feedback  Competition  A system can motivate users to adopt a target attitude or behavior by leveraging human beings’ natural drive to compete.  - Mission that stimulates quitting together with a friend - Social network - Progress feedback  Recognition  By offering public recognition for an individual or group, a system can increase the likelihood that a person/ group will adopt a target behavior.  - Personalized stories of Kick.it users- Social network - Progress feedback  Category  PSD element  Description  Kick.it features  Quotes belonging to domain (main PSD element)  Primary Task Support  Reduction  A system that reduces complex behavior into simple tasks helps users perform the target behavior, and it may increase the benefit/cost ratio of a behavior.  - Logging cigarettes smoked and cravings felt - Missions - Reminders - Kick stack  HP6: “It has to be fairly simple to use. Even if patients have worked out how to use their phone, that does not mean they know how to access other things that are on their phone.” (Reduction) SM3: “You know it has got to be easy, I am wearing glasses. It needs to be easy to look at being an older person.” (Reduction) HP1: "It needs to have a lot of options so you can tailor it for each person.” (Tailoring) HP7: "Smoking cessation advice always depends on the person, so tailoring in the app is important." (Tailoring) SM1: “I would not care; [social comparison] would not have any effect on me… If my friends have not smoked for a week, to me that does not mean anything. I’m just concerned about my health.” (Tailoring) SM6: “The app has to be able to adapt… if the person is 55 years old, it is not treating them like they are 15 years old. Conversely, if they are 25 year old they will not be spoken to like a 60 year old.” (Tailoring) HP1: “Or they could say put a photo of their grandchild and then write ‘want to see [your grandchild] go to school’ or something like that, so that their phone pops this up, so when they want to smoke they reach for their phone and it goes ‘Don’t smoke that cigarette, want to see [your grandchild] go to school’.” [Personalization] SM4: "Going back to the financial aspect. If you were to say you know: you put in how much a packet of cigarettes has been over a certain amount of time. You spend this amount of money and you say that is equivalent to [something] you put in the beginning. Like the things you like to do, like travel, or go to shows, or buy clothes or whatever. That is equivalent to, you could have gone to Bali. That could be an incentive for people." (Personalization) HP7: "I like that I can see my progress on a daily basis, but also from month to month when [I use other apps]. That could also work for Kick.it." (Self-monitoring) HP9: “You know what would be perfect… it would be awesome if the app could tell us when they last smoked. It would be so cool to have an app that validates people, you know to monitor them.” (Self-monitoring) HP2: "What if you had a visual Tamagotchi kind of thing, that if they didn't stay abstinent, it would slowly get sicker." (simulation)  Tunnelling  Using the system to guide users through a process or experience provides opportunities to persuade along the way.  - Log crave and smoke - Kick Stack- Social network  Tailoring  Information provided by the system will be more persuasive if it is tailored to the potential needs, interests, personality, usage context, or other factors relevant to a user group.  - Missions- Individualized treatment plan - Future tailoring based on individual characteristics  Personalization  A system that offers personalized content or services has a greater capability for persuasion.  - Kick Stack - Social network - Future tailoring based on individual characteristics  Self-monitoring  A system that keeps track of one’s own performance or status supports the user in achieving goals  - Health and monetary feedback- Craving Tracker- Missions- Feedback in Kick Stack  Simulation  Systems that provide simulations can persuade by enabling users to observe immediately the link between cause and effect.  - Educational and motivational videos  Rehearsal  A system providing means with which to rehearse a behavior can enable people to change their attitudes or behavior in the real world.  - Missions- Kick Stack  Dialogue support  Praise  By offering praise, a system can make users more open to persuasion.  - Kick Stack- Social network- Health and monetary feedback- Missions  HP3: "“I think feedback is very important, because the patients become very proud when I ask them to lose some weight, they come back saying have a look [at personal weight app], see so many km in the past few days, so I think the feedback from the app to the patients, is the most important thing”(Praise) SM1: "The health aspect and the savings. Having that constant content pushing while you go about your daily activities. Having that come up like bang you know` you saved 290 dollar on ciggies in weeks. That was important. To sort of push it along the way" (praise) HP1: “You should get a sponsor from a nicotine replacement company… the more points they get, they can cash it in with a loyalty card at [a local business] for Nicotine Replacement Therapy”. (rewards) HP10: “harnessing the interest of people, making them come back. They have to come back. With built in incentives. Some people will get excited to see how many emoji’s they got, some people won’t”. (rewards) HP4: "if the app gives a beep to remind you that you haven't checked in for the day, how are you going? [you think] Ah ok I got to do this, it is kind of a reinforcement of 'ah yes I am doing this and this is what I need to work towards" (reminder) HP9: “Using real people, using images they can relate to... local people” (similarity) HP9: " It needs to be visual…[ [My patients] don't really like to read that much, so it should not require a lot of reading. Video's, Images." (liking) SM6: “A bit of comedy, a bit of humour, just to keep people motivated [ to keep using the app]" (liking) SM9: “I’m interested in a visual story, for me a vidual story would be easy [to follow]”. (Liking) HP1: “[I want to see] Feedback on money. Something that shows them the reasons why stopping smoking is good. That might remind them at intervals (self-monitoring) SM7: “Tracking my progress and letting me learn from previous attempts [would be valuable functionality]  Rewards  Systems that reward target behaviors may have great persuasive powers  - Health and monetary feedback - Future gamification of quit process  Reminders  If a system reminds users of their target behavior, the users will more likely achieve their goals.  - Push notifications- Health feedback  Suggestion  Systems offering fitting suggestions will have greater persuasive powers.  - Kick Stack- Social network- Push notifications  Similarity  People are more readily persuaded through systems that remind them of themselves in some meaningful way.  - Different versions tailored to user characteristics (e.g., indigenous, mental health)- Future availability in different languages  Liking  A system that is visually attractive for its users is likely to be more persuasive.  - Visual health feedback - Use of GIF's and videos rather than text- use of emoji’s  Social role  If a system adopts a social role, users will more likely use it for persuasive purposes.  - Future integration of bot or avatar - Social network  System credibility  Trustworthiness  A system that is viewed as trustworthy will have increased powers of persuasion.  - Logos of collaborative partners - Research focus  HP1: “You need to say that we won’t identify [the user], and that your privacy will always be respected.” (Trustworthiness) SM6: “When you are using the app it [needs to] look like it was written by people who knew what they were doing. One of the significant things with anything technology-based, it has to instil confidence from the user.” (Expertise) SM1: “If I was looking for an app for running, I would not go for anything that is low rated or not downloaded. So unless it is something specific I am going for and I am looking for it, you always look at the top tier [for downloads].” (Surface credibility) SM5: “If I found [Kick.it] interesting… I will see how many people downloaded it first, then I will download it. So that’s uh, if you want to attract me or something that’s one of the things.” (Surface credibility) SM8: “I used one of the government quit smoking apps, but it was very surfacy… it just was not good enough.” (Surface credibility) HP6: “If you can involve Quitline that would be an option as well. As you know Quitline is a big organization and if you can involve Quitline then they maybe will be doing some marketing and will help with getting more people… on the same time you can add a button so people can call Quitline if they are in trouble.” (Authority/third-party endorsement)    Expertise  A system that is viewed as incorporating expertise will have increased powers of persuasion.  - Logos of collaborative partners - Laymen explanation of journal articles on Kick.it are pushed through feeds    Surface credibility  People make initial assessments of the system credibility based on a firsthand inspection.  - Ensure high reviews and ratings in app store - Research focus of the app    Real-world feel  A system that highlights people or organization behind its content or services will have more credibility.  - Constant publication of real user experiences in-app and social network    Authority  A system that leverages roles of authority will have enhanced powers of persuasion.  - University and research institute Endorsement and research focus of the app    Third-party endorsements  Third-party endorsements, especially from well-known and respected sources, boost perceptions on system credibility.  - University, health professional, and research institute endorsement      Verifiability  Credibility perceptions will be enhanced if a system makes it easy to verify the accuracy of site content via outside sources.  - Information in app will (where possible) have referencing or link-outs    Social support  Social learning  A person will be more motivated to perform a target behavior if (s)he can use a system to observe others performing the behavior.  - Social network - Progress feedback  SM5 “what might work is for example if there is a push notification [saying] ‘ok two of your friends didn’t smoke today, or two of your friends only smoked this amount today, they have decreased their smoking’. So I can see my friends are slowing down.” (Social learning) HP1 - "what you want is people in Kick.it that are in your immediate vicinity, so if you are in a pub you can go up and make friends with them, Like Tinder." (Social facilitation) HP10 - “I think the forum, the forum is really the one, because you can feed that [with content].” (Social facilitation) SM6: “Who are you talking to? Some stranger. You don’t know who that person is, what’s their experience… When you are crying on somebodies shoulder, you want to have some level of understanding. Not some scripted response. That’s where you need your buddy. In fact, that’s where an avatar based app can come in. Somebody you can talk to… And the app talks back to you. For a single person quitting on their own they need to build a relationship with somebody.” (Social facilitation) HP10 - “It would need to have incentives, like winning things and adding badges and all that stuff that people get competitive about.” (Competition) SM4: Yeah so for "Map my run"… I can see when [friend] and another few mates of mine who are using it, when they have a workout we can comment, hey i like that you just done that and we can have communication through that app as well. (Cooperation) SM3: For me it’s the human community... if you are going to succumb to a ciggie, you can find a buddy. (Social facilitation) SM4: Half the time when you want to have a cigarette, you really have the thoughts: I want to have that cigarette, I want to have that cigarette... [if then] someone else goes like “do not worry about it, don’t do it”, somebody else that stimulates you and takes you on another track. (Social facilitation)  Social comparison  System users will have a greater motivation to perform the target behavior if they can compare their performance with the performance of others.  - Missions - Social network - Progress feedback  Normative influence  A system can leverage normative influence or peer pressure to increase the likelihood that a person will adopt a target behavior  - Missions - Social network - Progress feedback  Social facilitation  System users are more likely to perform target behavior if they discern via the system that others are performing the behavior along with them.  - Social network - Progress feedback  Cooperation  A system can motivate users to adopt a target attitude or behavior by leveraging human beings’ natural drive to co-operate  - Mission that stimulates quitting together with a friend - Social network - Progress feedback  Competition  A system can motivate users to adopt a target attitude or behavior by leveraging human beings’ natural drive to compete.  - Mission that stimulates quitting together with a friend - Social network - Progress feedback  Recognition  By offering public recognition for an individual or group, a system can increase the likelihood that a person/ group will adopt a target behavior.  - Personalized stories of Kick.it users- Social network - Progress feedback  Kick.it’s core features matched to the PSD Framework [20]. The most left column provides one of the four categories of design functionality, subdivided into 28 design principles (second column from the left). The principles are explained in the third column and matched to the core Kick.it functionalities in the fourth column. The final column provides example quotes from participants in the focus group and interviews regarding potential useful functionality. View Large Table 3 Description of the Persuasive System Design (PSD) Framework with example features of Kick.it and quotes of the qualitative interviews Category  PSD element  Description  Kick.it features  Quotes belonging to domain (main PSD element)  Primary Task Support  Reduction  A system that reduces complex behavior into simple tasks helps users perform the target behavior, and it may increase the benefit/cost ratio of a behavior.  - Logging cigarettes smoked and cravings felt - Missions - Reminders - Kick stack  HP6: “It has to be fairly simple to use. Even if patients have worked out how to use their phone, that does not mean they know how to access other things that are on their phone.” (Reduction) SM3: “You know it has got to be easy, I am wearing glasses. It needs to be easy to look at being an older person.” (Reduction) HP1: "It needs to have a lot of options so you can tailor it for each person.” (Tailoring) HP7: "Smoking cessation advice always depends on the person, so tailoring in the app is important." (Tailoring) SM1: “I would not care; [social comparison] would not have any effect on me… If my friends have not smoked for a week, to me that does not mean anything. I’m just concerned about my health.” (Tailoring) SM6: “The app has to be able to adapt… if the person is 55 years old, it is not treating them like they are 15 years old. Conversely, if they are 25 year old they will not be spoken to like a 60 year old.” (Tailoring) HP1: “Or they could say put a photo of their grandchild and then write ‘want to see [your grandchild] go to school’ or something like that, so that their phone pops this up, so when they want to smoke they reach for their phone and it goes ‘Don’t smoke that cigarette, want to see [your grandchild] go to school’.” [Personalization] SM4: "Going back to the financial aspect. If you were to say you know: you put in how much a packet of cigarettes has been over a certain amount of time. You spend this amount of money and you say that is equivalent to [something] you put in the beginning. Like the things you like to do, like travel, or go to shows, or buy clothes or whatever. That is equivalent to, you could have gone to Bali. That could be an incentive for people." (Personalization) HP7: "I like that I can see my progress on a daily basis, but also from month to month when [I use other apps]. That could also work for Kick.it." (Self-monitoring) HP9: “You know what would be perfect… it would be awesome if the app could tell us when they last smoked. It would be so cool to have an app that validates people, you know to monitor them.” (Self-monitoring) HP2: "What if you had a visual Tamagotchi kind of thing, that if they didn't stay abstinent, it would slowly get sicker." (simulation)  Tunnelling  Using the system to guide users through a process or experience provides opportunities to persuade along the way.  - Log crave and smoke - Kick Stack- Social network  Tailoring  Information provided by the system will be more persuasive if it is tailored to the potential needs, interests, personality, usage context, or other factors relevant to a user group.  - Missions- Individualized treatment plan - Future tailoring based on individual characteristics  Personalization  A system that offers personalized content or services has a greater capability for persuasion.  - Kick Stack - Social network - Future tailoring based on individual characteristics  Self-monitoring  A system that keeps track of one’s own performance or status supports the user in achieving goals  - Health and monetary feedback- Craving Tracker- Missions- Feedback in Kick Stack  Simulation  Systems that provide simulations can persuade by enabling users to observe immediately the link between cause and effect.  - Educational and motivational videos  Rehearsal  A system providing means with which to rehearse a behavior can enable people to change their attitudes or behavior in the real world.  - Missions- Kick Stack  Dialogue support  Praise  By offering praise, a system can make users more open to persuasion.  - Kick Stack- Social network- Health and monetary feedback- Missions  HP3: "“I think feedback is very important, because the patients become very proud when I ask them to lose some weight, they come back saying have a look [at personal weight app], see so many km in the past few days, so I think the feedback from the app to the patients, is the most important thing”(Praise) SM1: "The health aspect and the savings. Having that constant content pushing while you go about your daily activities. Having that come up like bang you know` you saved 290 dollar on ciggies in weeks. That was important. To sort of push it along the way" (praise) HP1: “You should get a sponsor from a nicotine replacement company… the more points they get, they can cash it in with a loyalty card at [a local business] for Nicotine Replacement Therapy”. (rewards) HP10: “harnessing the interest of people, making them come back. They have to come back. With built in incentives. Some people will get excited to see how many emoji’s they got, some people won’t”. (rewards) HP4: "if the app gives a beep to remind you that you haven't checked in for the day, how are you going? [you think] Ah ok I got to do this, it is kind of a reinforcement of 'ah yes I am doing this and this is what I need to work towards" (reminder) HP9: “Using real people, using images they can relate to... local people” (similarity) HP9: " It needs to be visual…[ [My patients] don't really like to read that much, so it should not require a lot of reading. Video's, Images." (liking) SM6: “A bit of comedy, a bit of humour, just to keep people motivated [ to keep using the app]" (liking) SM9: “I’m interested in a visual story, for me a vidual story would be easy [to follow]”. (Liking) HP1: “[I want to see] Feedback on money. Something that shows them the reasons why stopping smoking is good. That might remind them at intervals (self-monitoring) SM7: “Tracking my progress and letting me learn from previous attempts [would be valuable functionality]  Rewards  Systems that reward target behaviors may have great persuasive powers  - Health and monetary feedback - Future gamification of quit process  Reminders  If a system reminds users of their target behavior, the users will more likely achieve their goals.  - Push notifications- Health feedback  Suggestion  Systems offering fitting suggestions will have greater persuasive powers.  - Kick Stack- Social network- Push notifications  Similarity  People are more readily persuaded through systems that remind them of themselves in some meaningful way.  - Different versions tailored to user characteristics (e.g., indigenous, mental health)- Future availability in different languages  Liking  A system that is visually attractive for its users is likely to be more persuasive.  - Visual health feedback - Use of GIF's and videos rather than text- use of emoji’s  Social role  If a system adopts a social role, users will more likely use it for persuasive purposes.  - Future integration of bot or avatar - Social network  System credibility  Trustworthiness  A system that is viewed as trustworthy will have increased powers of persuasion.  - Logos of collaborative partners - Research focus  HP1: “You need to say that we won’t identify [the user], and that your privacy will always be respected.” (Trustworthiness) SM6: “When you are using the app it [needs to] look like it was written by people who knew what they were doing. One of the significant things with anything technology-based, it has to instil confidence from the user.” (Expertise) SM1: “If I was looking for an app for running, I would not go for anything that is low rated or not downloaded. So unless it is something specific I am going for and I am looking for it, you always look at the top tier [for downloads].” (Surface credibility) SM5: “If I found [Kick.it] interesting… I will see how many people downloaded it first, then I will download it. So that’s uh, if you want to attract me or something that’s one of the things.” (Surface credibility) SM8: “I used one of the government quit smoking apps, but it was very surfacy… it just was not good enough.” (Surface credibility) HP6: “If you can involve Quitline that would be an option as well. As you know Quitline is a big organization and if you can involve Quitline then they maybe will be doing some marketing and will help with getting more people… on the same time you can add a button so people can call Quitline if they are in trouble.” (Authority/third-party endorsement)    Expertise  A system that is viewed as incorporating expertise will have increased powers of persuasion.  - Logos of collaborative partners - Laymen explanation of journal articles on Kick.it are pushed through feeds    Surface credibility  People make initial assessments of the system credibility based on a firsthand inspection.  - Ensure high reviews and ratings in app store - Research focus of the app    Real-world feel  A system that highlights people or organization behind its content or services will have more credibility.  - Constant publication of real user experiences in-app and social network    Authority  A system that leverages roles of authority will have enhanced powers of persuasion.  - University and research institute Endorsement and research focus of the app    Third-party endorsements  Third-party endorsements, especially from well-known and respected sources, boost perceptions on system credibility.  - University, health professional, and research institute endorsement      Verifiability  Credibility perceptions will be enhanced if a system makes it easy to verify the accuracy of site content via outside sources.  - Information in app will (where possible) have referencing or link-outs    Social support  Social learning  A person will be more motivated to perform a target behavior if (s)he can use a system to observe others performing the behavior.  - Social network - Progress feedback  SM5 “what might work is for example if there is a push notification [saying] ‘ok two of your friends didn’t smoke today, or two of your friends only smoked this amount today, they have decreased their smoking’. So I can see my friends are slowing down.” (Social learning) HP1 - "what you want is people in Kick.it that are in your immediate vicinity, so if you are in a pub you can go up and make friends with them, Like Tinder." (Social facilitation) HP10 - “I think the forum, the forum is really the one, because you can feed that [with content].” (Social facilitation) SM6: “Who are you talking to? Some stranger. You don’t know who that person is, what’s their experience… When you are crying on somebodies shoulder, you want to have some level of understanding. Not some scripted response. That’s where you need your buddy. In fact, that’s where an avatar based app can come in. Somebody you can talk to… And the app talks back to you. For a single person quitting on their own they need to build a relationship with somebody.” (Social facilitation) HP10 - “It would need to have incentives, like winning things and adding badges and all that stuff that people get competitive about.” (Competition) SM4: Yeah so for "Map my run"… I can see when [friend] and another few mates of mine who are using it, when they have a workout we can comment, hey i like that you just done that and we can have communication through that app as well. (Cooperation) SM3: For me it’s the human community... if you are going to succumb to a ciggie, you can find a buddy. (Social facilitation) SM4: Half the time when you want to have a cigarette, you really have the thoughts: I want to have that cigarette, I want to have that cigarette... [if then] someone else goes like “do not worry about it, don’t do it”, somebody else that stimulates you and takes you on another track. (Social facilitation)  Social comparison  System users will have a greater motivation to perform the target behavior if they can compare their performance with the performance of others.  - Missions - Social network - Progress feedback  Normative influence  A system can leverage normative influence or peer pressure to increase the likelihood that a person will adopt a target behavior  - Missions - Social network - Progress feedback  Social facilitation  System users are more likely to perform target behavior if they discern via the system that others are performing the behavior along with them.  - Social network - Progress feedback  Cooperation  A system can motivate users to adopt a target attitude or behavior by leveraging human beings’ natural drive to co-operate  - Mission that stimulates quitting together with a friend - Social network - Progress feedback  Competition  A system can motivate users to adopt a target attitude or behavior by leveraging human beings’ natural drive to compete.  - Mission that stimulates quitting together with a friend - Social network - Progress feedback  Recognition  By offering public recognition for an individual or group, a system can increase the likelihood that a person/ group will adopt a target behavior.  - Personalized stories of Kick.it users- Social network - Progress feedback  Category  PSD element  Description  Kick.it features  Quotes belonging to domain (main PSD element)  Primary Task Support  Reduction  A system that reduces complex behavior into simple tasks helps users perform the target behavior, and it may increase the benefit/cost ratio of a behavior.  - Logging cigarettes smoked and cravings felt - Missions - Reminders - Kick stack  HP6: “It has to be fairly simple to use. Even if patients have worked out how to use their phone, that does not mean they know how to access other things that are on their phone.” (Reduction) SM3: “You know it has got to be easy, I am wearing glasses. It needs to be easy to look at being an older person.” (Reduction) HP1: "It needs to have a lot of options so you can tailor it for each person.” (Tailoring) HP7: "Smoking cessation advice always depends on the person, so tailoring in the app is important." (Tailoring) SM1: “I would not care; [social comparison] would not have any effect on me… If my friends have not smoked for a week, to me that does not mean anything. I’m just concerned about my health.” (Tailoring) SM6: “The app has to be able to adapt… if the person is 55 years old, it is not treating them like they are 15 years old. Conversely, if they are 25 year old they will not be spoken to like a 60 year old.” (Tailoring) HP1: “Or they could say put a photo of their grandchild and then write ‘want to see [your grandchild] go to school’ or something like that, so that their phone pops this up, so when they want to smoke they reach for their phone and it goes ‘Don’t smoke that cigarette, want to see [your grandchild] go to school’.” [Personalization] SM4: "Going back to the financial aspect. If you were to say you know: you put in how much a packet of cigarettes has been over a certain amount of time. You spend this amount of money and you say that is equivalent to [something] you put in the beginning. Like the things you like to do, like travel, or go to shows, or buy clothes or whatever. That is equivalent to, you could have gone to Bali. That could be an incentive for people." (Personalization) HP7: "I like that I can see my progress on a daily basis, but also from month to month when [I use other apps]. That could also work for Kick.it." (Self-monitoring) HP9: “You know what would be perfect… it would be awesome if the app could tell us when they last smoked. It would be so cool to have an app that validates people, you know to monitor them.” (Self-monitoring) HP2: "What if you had a visual Tamagotchi kind of thing, that if they didn't stay abstinent, it would slowly get sicker." (simulation)  Tunnelling  Using the system to guide users through a process or experience provides opportunities to persuade along the way.  - Log crave and smoke - Kick Stack- Social network  Tailoring  Information provided by the system will be more persuasive if it is tailored to the potential needs, interests, personality, usage context, or other factors relevant to a user group.  - Missions- Individualized treatment plan - Future tailoring based on individual characteristics  Personalization  A system that offers personalized content or services has a greater capability for persuasion.  - Kick Stack - Social network - Future tailoring based on individual characteristics  Self-monitoring  A system that keeps track of one’s own performance or status supports the user in achieving goals  - Health and monetary feedback- Craving Tracker- Missions- Feedback in Kick Stack  Simulation  Systems that provide simulations can persuade by enabling users to observe immediately the link between cause and effect.  - Educational and motivational videos  Rehearsal  A system providing means with which to rehearse a behavior can enable people to change their attitudes or behavior in the real world.  - Missions- Kick Stack  Dialogue support  Praise  By offering praise, a system can make users more open to persuasion.  - Kick Stack- Social network- Health and monetary feedback- Missions  HP3: "“I think feedback is very important, because the patients become very proud when I ask them to lose some weight, they come back saying have a look [at personal weight app], see so many km in the past few days, so I think the feedback from the app to the patients, is the most important thing”(Praise) SM1: "The health aspect and the savings. Having that constant content pushing while you go about your daily activities. Having that come up like bang you know` you saved 290 dollar on ciggies in weeks. That was important. To sort of push it along the way" (praise) HP1: “You should get a sponsor from a nicotine replacement company… the more points they get, they can cash it in with a loyalty card at [a local business] for Nicotine Replacement Therapy”. (rewards) HP10: “harnessing the interest of people, making them come back. They have to come back. With built in incentives. Some people will get excited to see how many emoji’s they got, some people won’t”. (rewards) HP4: "if the app gives a beep to remind you that you haven't checked in for the day, how are you going? [you think] Ah ok I got to do this, it is kind of a reinforcement of 'ah yes I am doing this and this is what I need to work towards" (reminder) HP9: “Using real people, using images they can relate to... local people” (similarity) HP9: " It needs to be visual…[ [My patients] don't really like to read that much, so it should not require a lot of reading. Video's, Images." (liking) SM6: “A bit of comedy, a bit of humour, just to keep people motivated [ to keep using the app]" (liking) SM9: “I’m interested in a visual story, for me a vidual story would be easy [to follow]”. (Liking) HP1: “[I want to see] Feedback on money. Something that shows them the reasons why stopping smoking is good. That might remind them at intervals (self-monitoring) SM7: “Tracking my progress and letting me learn from previous attempts [would be valuable functionality]  Rewards  Systems that reward target behaviors may have great persuasive powers  - Health and monetary feedback - Future gamification of quit process  Reminders  If a system reminds users of their target behavior, the users will more likely achieve their goals.  - Push notifications- Health feedback  Suggestion  Systems offering fitting suggestions will have greater persuasive powers.  - Kick Stack- Social network- Push notifications  Similarity  People are more readily persuaded through systems that remind them of themselves in some meaningful way.  - Different versions tailored to user characteristics (e.g., indigenous, mental health)- Future availability in different languages  Liking  A system that is visually attractive for its users is likely to be more persuasive.  - Visual health feedback - Use of GIF's and videos rather than text- use of emoji’s  Social role  If a system adopts a social role, users will more likely use it for persuasive purposes.  - Future integration of bot or avatar - Social network  System credibility  Trustworthiness  A system that is viewed as trustworthy will have increased powers of persuasion.  - Logos of collaborative partners - Research focus  HP1: “You need to say that we won’t identify [the user], and that your privacy will always be respected.” (Trustworthiness) SM6: “When you are using the app it [needs to] look like it was written by people who knew what they were doing. One of the significant things with anything technology-based, it has to instil confidence from the user.” (Expertise) SM1: “If I was looking for an app for running, I would not go for anything that is low rated or not downloaded. So unless it is something specific I am going for and I am looking for it, you always look at the top tier [for downloads].” (Surface credibility) SM5: “If I found [Kick.it] interesting… I will see how many people downloaded it first, then I will download it. So that’s uh, if you want to attract me or something that’s one of the things.” (Surface credibility) SM8: “I used one of the government quit smoking apps, but it was very surfacy… it just was not good enough.” (Surface credibility) HP6: “If you can involve Quitline that would be an option as well. As you know Quitline is a big organization and if you can involve Quitline then they maybe will be doing some marketing and will help with getting more people… on the same time you can add a button so people can call Quitline if they are in trouble.” (Authority/third-party endorsement)    Expertise  A system that is viewed as incorporating expertise will have increased powers of persuasion.  - Logos of collaborative partners - Laymen explanation of journal articles on Kick.it are pushed through feeds    Surface credibility  People make initial assessments of the system credibility based on a firsthand inspection.  - Ensure high reviews and ratings in app store - Research focus of the app    Real-world feel  A system that highlights people or organization behind its content or services will have more credibility.  - Constant publication of real user experiences in-app and social network    Authority  A system that leverages roles of authority will have enhanced powers of persuasion.  - University and research institute Endorsement and research focus of the app    Third-party endorsements  Third-party endorsements, especially from well-known and respected sources, boost perceptions on system credibility.  - University, health professional, and research institute endorsement      Verifiability  Credibility perceptions will be enhanced if a system makes it easy to verify the accuracy of site content via outside sources.  - Information in app will (where possible) have referencing or link-outs    Social support  Social learning  A person will be more motivated to perform a target behavior if (s)he can use a system to observe others performing the behavior.  - Social network - Progress feedback  SM5 “what might work is for example if there is a push notification [saying] ‘ok two of your friends didn’t smoke today, or two of your friends only smoked this amount today, they have decreased their smoking’. So I can see my friends are slowing down.” (Social learning) HP1 - "what you want is people in Kick.it that are in your immediate vicinity, so if you are in a pub you can go up and make friends with them, Like Tinder." (Social facilitation) HP10 - “I think the forum, the forum is really the one, because you can feed that [with content].” (Social facilitation) SM6: “Who are you talking to? Some stranger. You don’t know who that person is, what’s their experience… When you are crying on somebodies shoulder, you want to have some level of understanding. Not some scripted response. That’s where you need your buddy. In fact, that’s where an avatar based app can come in. Somebody you can talk to… And the app talks back to you. For a single person quitting on their own they need to build a relationship with somebody.” (Social facilitation) HP10 - “It would need to have incentives, like winning things and adding badges and all that stuff that people get competitive about.” (Competition) SM4: Yeah so for "Map my run"… I can see when [friend] and another few mates of mine who are using it, when they have a workout we can comment, hey i like that you just done that and we can have communication through that app as well. (Cooperation) SM3: For me it’s the human community... if you are going to succumb to a ciggie, you can find a buddy. (Social facilitation) SM4: Half the time when you want to have a cigarette, you really have the thoughts: I want to have that cigarette, I want to have that cigarette... [if then] someone else goes like “do not worry about it, don’t do it”, somebody else that stimulates you and takes you on another track. (Social facilitation)  Social comparison  System users will have a greater motivation to perform the target behavior if they can compare their performance with the performance of others.  - Missions - Social network - Progress feedback  Normative influence  A system can leverage normative influence or peer pressure to increase the likelihood that a person will adopt a target behavior  - Missions - Social network - Progress feedback  Social facilitation  System users are more likely to perform target behavior if they discern via the system that others are performing the behavior along with them.  - Social network - Progress feedback  Cooperation  A system can motivate users to adopt a target attitude or behavior by leveraging human beings’ natural drive to co-operate  - Mission that stimulates quitting together with a friend - Social network - Progress feedback  Competition  A system can motivate users to adopt a target attitude or behavior by leveraging human beings’ natural drive to compete.  - Mission that stimulates quitting together with a friend - Social network - Progress feedback  Recognition  By offering public recognition for an individual or group, a system can increase the likelihood that a person/ group will adopt a target behavior.  - Personalized stories of Kick.it users- Social network - Progress feedback  Kick.it’s core features matched to the PSD Framework [20]. The most left column provides one of the four categories of design functionality, subdivided into 28 design principles (second column from the left). The principles are explained in the third column and matched to the core Kick.it functionalities in the fourth column. The final column provides example quotes from participants in the focus group and interviews regarding potential useful functionality. View Large Smoke and Crave profile Kick.it stimulates users to log crave- or smoke-related data using Ecological Momentary Assessment [84, 85], combining user-generated (mood, trigger, strength of crave, or desire to smoke) and system-generated (time and location) data, thereby forming a detailed profile of the smoking or quitting behavior. This personalized data will be visualized in the user profile and provides direct health behavioral feedback, with the aim to facilitate self-monitoring. This logged information can benefit the users in the short- and long term. In the short term, this information can be used to adjust the content the app displays. For instance, capturing a sudden increase in cravings and urges may signal a risk of relapse [86, 87] and can trigger the app to intensify the recommendations to deal with this crave. In the long term, researchers can study the user data over a period of time, which can lead to app updates. While this may thus not necessarily benefit the user during one quit attempt, it can lead to benefits in case they return to the app at a later stage (e.g., they relapsed and need to give it another go) or can benefit future users. Kick stack After logging a smoke or a crave, the user is directed to a “kick stack,” which features content aimed at ensuring that the user is able to deal with the urges of wanting to smoke. The content spans a wide range of topics and ranges from content based on the 5 D’s: Drink water, Deep breathe, Distract yourself, Do something Else, Discuss with friend/family, to mindfulness techniques to deal with cravings [83], and from motivational content to boost their behavioral capacity, to content aimed at improving their skill to deal with tempting situations. The content in the “kick stack” is updated continuously and displayed in different formats. This is based on the principle of “variable reward” [88] or in other words providing new (and rewarding) content on a variable ratio schedule of reinforcement [89]. This ensures that the users see “new” content and strategies to deal with cravings each time they return to Kick.it, which is hypothesized to draw users back to the app, similar to how the expectation of new content on social networks keeps users returning [90]. The end goal of the use of the “kick stack” is the formulation of a personal coping strategy for cravings; the users keep trying different methods, they will select the ones that work for them and will discard the ones that do not. Social support and information network The importance of social support in addressing addictions is widely recognized, but the efficacy of online social support networks for increasing smoking abstinence has not yet been reliably shown [91–93]. Rather than using the social network as a tool to increase abstinence by itself, Kick.it utilizes it to increase attractiveness of and engagement with the app [94]. The network will be populated by friends and family originating from users’ offline network, as well as other users (e.g., ex-smokers) of whom a proportion will take on the roll as super users [95]. The network will incorporate special content for each user type, to ensure that even social supporters and super users find relevant content. By launching the app for use around the world, the social network can be utilized as a 24/7 “rapid-response” intervention that can be accessed virtually immediately [96]. The social network also functions as a mechanism for users to share tips and tricks, and for Kick.it to disseminate more quit smoking information. Missions and treatment goals The user will have access to daily “missions” that aim to increase self-control and the user’s ability to withstand social influence to smoke (e.g., keep a smoke-free house and develop strategies to counter social influence), and eventually will form part of their quit smoking strategy. The content of this course is largely based on the behavioral change taxonomy for smoking cessation [26] and uses a number of methods to increase self-control, for example, the formation of implementation intentions [97] and coping planning [98]. If a user indicates to use pharmacological treatment, the missions will be supplemented with additional content aimed at increasing medication adherence. Discussion This study used the IM framework to guide the development of a smartphone app for smoking cessation. There are hundreds of quit smoking apps in the app- and play store [99, 100], only a small portion has been or is currently being studied [101–107]. While Kick.it shows similarities with these apps, for instance in choice of some functionality, there are a number of areas of differences. The needs assessment in Step 1 highlighted the need for a smartphone app that allowed a high degree of tailoring and individualization, as successful smoking cessation can be influenced by a wide range of factors including but not limited to demographic characteristics (e.g., gender, ethnicity, and SES), the use of pharmacotherapy or behavioral counselling, the availability of social support, and appropriate planning of the quit attempt. Rather than designing an app that uses one specific approach to smoking cessation, for instance designing an app based on acceptance and commitment therapy [102] or mindfulness [104], or an app that focuses on one user group, for example, pregnant smokers [105] or young smokers [107], the project team decided to build a general smoking cessation platform that allows the development of an infinite amount of modules and subapps aimed at becoming a one-stop solution for all smokers, regardless of the user’s individual characteristics. The currently available apps focus predominantly on influencing the success rate of a single quit smoking attempt. While some apps allow lapses to occur, for instance SmokeFree28106, the apps do not specifically focus on supporting the smoker during multiple consecutive quit attempts. Furthermore, all apps aim to influence the behavior of the smoker and do not specifically set out to change the behavior of the social support network. Social supporters are open to being educated on smoking cessation and social support [108], and an online social network is the perfect vessel for testing different ways of facilitating social support, which can be used to further our understanding of social support in smoking cessation [54]. While the ultimate aim of Kick.it is to become a one-stop-shop for smoking cessation, the first versions that will be released are far from just that. Kick.it will be released as a minimal viable product (MVP) to the app store. Kick.it will start by focusing on developing a solution for motivated smokers, with only limited tailoring and personalization, and a staged release of additional functionality. Implementation of additional features will be based on overall positive user responses toward each feature using participatory user-centered design [109].The MVP will house four core features (social network, logging of cravings, the kick stack, and feedback on logged data), which will be assessed on usefulness, usability, and design, via in-app questionnaires, user testing via qualitative methods, and real-time usage data. Components or content that is not used and deemed not useful will be disabled. The effectiveness of the app, the usefulness of its components and the upgrades we plan to provide, will be assessed in a series of observational studies and a pilot randomized controlled trial, as soon as the app is stable and hosts the features that our main stakeholders would like to see included. This is the first limitation of our project. By releasing the app on the app store with multiple features included, it becomes difficult to assess the effectiveness of each individual component. While in an ideal world we would use an evaluation design such as the multi-phase optimization strategy (MOST) [110] to determine the effectiveness of each component, and subsequently being able to determine the optimal components of our quit smoking app, this project does not allow for such rigorous testing for pragmatic reasons. The project is a collaboration between an Australian start-up and the researchers involved, and works on a minimal budget; a budget that is nowhere near enough to warrant or enable extensive testing via for instance MOST. As a result, this project had and will continue to have to find a balance between conducting the most rigorous research as possible and ensuring a cost-effective and efficient product development process. While this is a definite limitation, our formative work, the detailed work on the theoretical underpinnings via the IM approach, the input of users via user testing before launch in the app store, and the fact that the smoking research field provides us with a large body of research to suggest what elements work and which do not, makes us confident this app can achieve similar positive outcomes than reported by other quit smoking apps [102, 103, 106]. A second limitation lies in the fact that the design of the initial MVP was less informed by the main stakeholders who were interviewed than planned, despite our initial intention to apply participatory user-centered design [109]. Our interviewees, both health professionals and smokers, had limited experience with and knowledge on smartphone apps for smoking cessation and health in general, a finding that is in line with existing research [111]. Rather we decided to use professional designers and developers to guide the initial components, in line with the PSD framework’s [20] recommendations. Main stakeholders, smokers, and health professionals will get the chance to propose design modifications down the track during beta testing. By using a comprehensive design framework, using professional designers, and our formative work, and tweaking the design later down the track, we remain confident about the design features of choice when the app gets released in the app store. This study joins Tombor et al [105]. in publishing the design process of a smartphone app for smoking cessation, with specific reference to reporting on the use of a rigorous methodology (in their case the BCW) to guide development of the app. By publishing the design process of Kick.it, we aim to ensure transparency and welcome other researchers to do the same. The ultimate goal is to advance the field of mHealth solutions for smoking cessation [112] and to get one step closer to creating a solution for all smokers who have the desire to kick their habit once and for all. SUPPLEMENTARY MATERIAL Supplementary material is available at Translational Behavioral Medicine online. Compliance with Ethical Standards Conflict of Interest: None of the authors declare a conflict of interest. Primary Data: The findings reported in this article have not been previously published and the manuscript is not being simultaneously submitted elsewhere. Some preliminary data was presented at the Annual General Meeting of the Thoracic Society of Australia and New Zealand, Perth 2016, doi:10.1111/resp.12754_11. Authors’ Contributions: The authors have full control of all primary data, and we agree to allow the journal to review our data if requested. Ethical Approval: We certify that all institutions involved in the study conducted the research according to the Ethical Standards for the Protection of Human Participants and Animals in Research according to the Helsinki Declaration of 1975. Ethics approval was obtained for this study by the Queen Elizabeth Human Research Ethics Committee (TQEH/LMH/MH), Adelaide (Australia). Ethics approval code: HREC/15/TQEH/187. Informed Consent: Informed consent was obtained from all individual participants included in the study. Acknowledgments This project has received a 25,000.00 Australian dollar grant from the Hospital Research Foundation (Adelaide, Australia). We would like to acknowledge James Stewart, CEO of Kick.it Pty Ltd, and the Kick.it team for their work on this collaborative project and their open-mindedness toward our partnership. References 1. West R, McNeill A, Raw M. Smoking cessation guidelines for health professionals: An update. Health Education Authority. 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TI - Kick.it: The development of an evidence-based smoking cessation smartphone app
JO - Translational Behavioral Medicine
DO - 10.1093/tbm/ibx031
DA - 2018-04-01
UR - https://www.deepdyve.com/lp/oxford-university-press/kick-it-the-development-of-an-evidence-based-smoking-cessation-Sli5IGzUYd
SP - 243
EP - 267
VL - 8
IS - 2
DP - DeepDyve
ER -